Almost 35 years ago American drug regulators approved Prozac, the first in a series of blockbuster antidepressants known as selective serotonin re-uptake inhibitors (ssris). Prozac and its cousins were lauded by patients and doctors as miracle drugs. They lifted low moods quickly and seemed to have no drawbacks. Divorce, bereavement, problems at work—a daily pill was there to help with that, and anything else which made you sad. Many people have stayed on these drugs for life. In Western countries today between one person in seven and one in ten takes antidepressants.

大約35年前，美國藥品監(jiān)管機構(gòu)批準了百憂解(一種抗抑郁藥)，這是選擇性血清素再吸收抑制劑(SSRIs)系列重磅抗抑郁藥中的第一種。百憂解和它的“近親”被病人和醫(yī)生譽為神奇的藥物。它們很快就擺脫了低落的情緒，似乎沒有任何缺點。離婚、喪親之痛、工作上的問題，每天吃一顆藥就能解決這些問題，還有其他任何讓你悲傷的事情。許多人終生服用這些藥物。今天在西方國家，七分之一到十分之一的人服用抗抑郁藥。

The shine of ssris has worn off. A growing number of studies show that they are less effective than thought. Drug companies often publish the results of clinical trials selectively, withholding those in which the drugs turn out not to work well. When the results of all trials submitted to America’s medicines regulator between 1979 and 2016 were scrutinised by independent scientists, it turned out that antidepressants had a substantial benefit beyond a placebo effect in only 15% of patients.

SSRIs的光芒已經(jīng)褪去。越來越多的研究表明，它們并沒有想象的那么有效。制藥公司經(jīng)常選擇性地公布臨床試驗結(jié)果，而不公布那些最終證明藥效不佳的結(jié)果。1979年至2016年期間，獨立科學家對提交給美國藥品監(jiān)管機構(gòu)的所有試驗結(jié)果進行了仔細檢查，結(jié)果發(fā)現(xiàn)，只有15% 的患者服用抗抑郁藥物后，獲得了比安慰劑效果更大的益處。

Clinical guidelines have been revised accordingly in recent years. No longer are drugs the recommended first line of treatment for less severe cases of depression. For these, self-help guidance, behavioural therapy and recommendations for things like exercise and sleep are preferable. For work burnout, a sick note for time off may suffice. The drugs are to be reserved only for more severe depression, where they can be truly life-saving.?

近年來，臨床指南進行了相應的修訂。藥物不再是治療輕度抑郁癥的首選治療方法。對于這些患有輕度抑郁癥的人來說，自助指導、行為療法和關(guān)于鍛煉和睡眠等方面的建議是更好的選擇。對于工作精疲力竭的人來說，病假條可能就足夠了。這些藥物只用于更嚴重的抑郁癥，在這種情況下，它們可以真正拯救生命。

The problem is that lots of people who do not need antidepressants are already on them, refilling prescriptions written years or even decades ago. They should be helped to get off the drugs. The side-effects are often life-limiting and, as people age, become life-threatening. They include sexual dysfunction (which sufferers describe as “genital anaesthesia”), lethargy, emotional numbness, increased risk of birth defects when taken during pregnancy, and, in older people, strokes, falls, seizures, heart problems and bleeding after surgery. This is a threat to health-care systems as long-term users age.

問題是，很多不需要抗抑郁藥的人已經(jīng)在服用抗抑郁藥了，他們的處方是幾年前甚至幾十年前開出的。應該幫助他們戒掉這些藥物。副作用往往會折壽，隨著年齡的增長，甚至會危及生命。這些副作用包括性功能障礙(患者將其描述為“生殖器感覺喪失”)、沒精打采、情感鈍化、懷孕期間服用，出生缺陷風險增加，以及老年人會中風、摔倒、癲癇、心臟病以及手術(shù)后出血。隨著長期使用者年齡的增長，這對醫(yī)療保健系統(tǒng)是一種威脅。

Doctors rarely talk to patients about stopping the drugs because they fear this could lead to a return of depressive symptoms. But for many people it may be safe to stop. Even among long-term users with several past episodes of depression, a recent trial in Britain showed that 44% of patients could stop taking pills safely. For milder cases, the success rate is probably higher still.

醫(yī)生很少和病人談論停藥，因為他們擔心這可能會導致抑郁癥狀復發(fā)。但對許多人來說，停藥可能是安全的。英國最近的一項試驗表明，即使是那些有過幾次抑郁癥經(jīng)歷的長期使用者，其中44%的患者可以安全地停藥。對于病情較輕的病例，成功率可能更高。

Several things are needed for change to happen. Doctors need guidelines on how to de-prescribe the drugs. Health-care insurers and providers such as Britain’s various national health services should start paying for ways of delivering the drugs that help those who wish to stop taking them but who need to taper off them in order to avoid severe withdrawal effects. These include liquid formulations, tapering strips which contain pills with progressively smaller drug concentrations, and the services of compounding pharmacies, which prepare bespoke doses. In the Netherlands, 70% of people using tapering strips have managed to quit successfully.

改變需要做幾件事。醫(yī)生需要指導如何去取消這些藥物的處方。醫(yī)療保險公司和英國各種國家醫(yī)療服務機構(gòu)等提供方應該開始為提供藥物的方式付費，以幫助那些希望停藥但需要逐漸減少用藥以避免嚴重的戒斷效應的人。這些包括液體制劑、含有藥物濃度逐漸減小的藥片的錐形條，以及配制定制劑量的復合藥房服務。在荷蘭，70%的使用錐形條的人都成功地戒掉了藥物。

All this could cost more than refilling prescriptions today. But with so many people on the drugs, the costs of side-effects will soon pile up. Add to that the misery of the millions whose lives have been robbed of their common joys by useless prescriptions, and the case for change is unanswerable.

這一切的花費可能比現(xiàn)在重新開處方還要高。但是有這么多人在使用這種藥物，副作用的成本很快就會增加。再加上那些被無用的處方剝奪了共同快樂的數(shù)百萬人的痛苦，改變的理由是無可辯駁的。