Could a drug prevent depression and PTSD? | Rebecca Brachman

Translator: Joseph Geni Reviewer: Joanna Pietrulewicz

Translator: Chile Martinussen Reviewer: Sune Vilsted Østergaard

This is a tuberculosis ward,

Dette er en tuberkuloseafdeling.

and at the time this picture was taken in the late 1800s,

Da dette billede blev taget i slutningen af 1800-tallet

one in seven of all people

døde ét ud af syv mennesker i verden

died from tuberculosis.

af tuberkulose.

We had no idea what was causing this disease.

Vi anede ikke, hvad der forårsagede sygdommen.

The hypothesis was actually

Hypotesen var faktisk,

it was your constitution that made you susceptible.

at det var din menneskelige tilstand, der gjorde dig modtagelig.

And it was a highly romanticized disease.

Det var en meget romantiseret sygdom.

It was also called consumption,

Sygdommen blev også kaldt konsumption,

and it was the disorder of poets

og var anset for at være en sygdom for poeter,

and artists and intellectuals.

kunstnere og intellektuelle.

And some people actually thought it gave you heightened sensitivity

Nogle mennesker troede faktisk, at sygdommen gjorde dig ekstra følsom,

and conferred creative genius.

og gav dig ekstraordinære kreative evner.

By the 1950s,

Omkring 1950'erne

we instead knew that tuberculosis was caused

vidste vi dog at tuberkulose var forårsaget af en

by a highly contagious bacterial infection,

yderst smitsom, bakteriel infektion,

which is slightly less romantic,

som er noget mindre romantisk.

but that had the upside

Dog havde det den positive egenskab,

of us being able to maybe develop drugs to treat it.

at vi nu kunne udvikle medicin, som måske kunne behandle sygdommen.

So doctors had discovered a new drug, iproniazid,

Læger havde opdaget et nyt medikament, iproniazid,

that they were optimistic might cure tuberculosis,

som de optimistisk troede kunne kurere tuberkulose.

and they gave it to patients,

De gav det til patienter

and patients were elated.

og patienterne blev opstemte.

They were more social, more energetic.

De blev mere sociale, mere energiske.

One medical report actually says they were "dancing in the halls."

En medicinsk rapport fortæller faktisk, at de "dansede på gangene".

And unfortunately,

Men desværre,

this was not necessarily because they were getting better.

var det ikke nødvendigvis fordi, de fik det bedre.

A lot of them were still dying.

Mange af patienterne døde stadig.

Another medical report describes them as being "inappropriately happy."

En anden medicinsk rapport beskrev dem som "upassende glade".

And that is how the first antidepressant was discovered.

Og således blev det første antidepressivum opdaget.

So accidental discovery is not uncommon in science,

Opfindelser ved en fejl er således ikke sjælden indenfor videnskaben,

but it requires more than just a happy accident.

men det kræver noget mere end blot held i uheld.

You have to be able to recognize it for discovery to occur.

Man bliver nødt til at kunne genkende det for at kunne opdage det.

As a neuroscientist, I'm going to talk to you a little bit

Som forsker i neurovidenskab, vil jeg fortælle en smule om

about my firsthand experience

min egen oplevelse med

with whatever you want to call the opposite of dumb luck --

hvad end du ønsker at kalde det modsatte af ren og skær held --

let's call it smart luck.

lad os kalde det intelligent held.

But first, a bit more background.

Men først lidt mere baggrundsviden.

Thankfully, since the 1950s,

Gudskelov, har vi siden 1950'erne

we've developed some other drugs and we can actually now cure tuberculosis.

udviklet andre typer medicin, og kan nu kurere tuberkulose.

And at least in the United States, though not necessarily in other countries,

I USA i hvert fald, ikke nødvendigvis i andre lande,

we have closed our sanitoriums

har vi lukket vores sanatorier,

and probably most of you are not too worried about TB.

og de fleste af jer er formentlig ikke særligt bekymrede for TB.

But a lot of what was true in the early 1900s

Men meget af det, vi vidste i det tidlige 1900-tal

about infectious disease,

om smitsomme sygdomme,

we can say now about psychiatric disorders.

kan vi nu sige om psykiatriske sygdomme.

We are in the middle of an epidemic of mood disorders

Vi står midt i en epidemi af psykiske sygdomme,

like depression and post-traumatic stress disorder, or PTSD.

som depression og posttraumatisk stress syndrom, eller PTSD.

One in four of all adults in the United States

Én ud af fire af alle voksne i USA

suffers from mental illness,

lider af en psykisk sygdom,

which means that if you haven't experienced it personally

som betyder, at hvis du ikke har oplevet det personligt

or someone in your family hasn't,

og ingen i din familie har,

it's still very likely that someone you know has,

er det stadig meget sandsynligt at nogen du kender har,

though they may not talk about it.

selv om de ikke snakker om det.

Depression has actually now surpassed

Depression har faktisk nu overhalet

HIV/AIDS, malaria, diabetes and war

HIV/AIDS, malaria, diabetes og krig,

as the leading cause of disability worldwide.

som den førende årsag til uarbejdsdygtighed i verden.

And also, like tuberculosis in the 1950s,

Og som tuberkulose i 1950'erne,

we don't know what causes it.

ved vi ikke hvad der forårsager det.

Once it's developed, it's chronic,

Når det er udviklet, er det kronisk,

lasts a lifetime,

varer livet ud,

and there are no known cures.

og der er ingen kendte kure for det.

The second antidepressant we discovered,

Det andet antidepressivum, vi opdagede,

also by accident, in the 1950s,

også ved et uheld i 1950'erne,

from an antihistamine that was making people manic,

fra en antihistamin der gjorde folk maniske,

imipramine.

var imipramin.

And in both the case of the tuberculosis ward and the antihistamine,

I begge tilfælde, både ved tuberkuloseafdelingen og antihistaminet,

someone had to be able to recognize

skulle nogen kunne genkende,

that a drug that was designed to do one thing --

at medicin som var designet til at gøre én ting --

treat tuberculosis or suppress allergies --

at behandle tuberkulose eller holde allergi i skak --

could be used to do something very different --

kunne anvendes til at gøre noget helt andet --

treat depression.

at behandle depression.

And this sort of repurposing is actually quite challenging.

Denne form for nyorientering er meget udfordrende.

When doctors first saw this mood-enhancing effect of iproniazid,

Da læger først så denne stemningsændrende effekt af iproniazid,

they didn't really recognize what they saw.

vedkendte de sig faktisk ikke, hvad de så.

They were so used to thinking about it

De var så vante til, at tænke på det

from the framework of being a tuberculosis drug

ud fra den ramme, at det var tuberkulosemedicin,

that they actually just listed it

at de blot oplistede den opløftende effekt,

as a side effect, an adverse side effect.

som en bivirkning, en ugunstig bivirkning.

As you can see here,

Som I kan se her,

a lot of these patients in 1954 are experiencing severe euphoria.

oplevede mange patienter i 1954 gennemgribende eufori.

And they were worried that this might somehow interfere

Lægestanden var bekymrede for, at dette ville gribe ind

with their recovering from tuberculosis.

i patienternes helbredelse af tuberkulose.

So they recommended that iproniazid only be used in cases of extreme TB

Så de anbefalede kun iproniazid i ekstreme TB-tilfælde,

and in patients that were highly emotionally stable,

og kun til patienter der var enormt emotionelt stabile,

which is of course the exact opposite of how we use it as an antidepressant.

som er den helt modsatte effekt af, hvordan vi bruger det som antidepressivum.

They were so used to looking at it from the perspective of this one disease,

De var så vant til at anskue dette, fra denne ene sygdoms perspektiv,

they could not see the larger implications for another disease.

at de ikke kunne gennemskue, at det kunne anvendes til en anden sygdom.

And to be fair, it's not entirely their fault.

Det er ikke kun deres fejl alene.

Functional fixedness is a bias that affects all of us.

Fastlåst fokus er en partiskhed, der påvirker os alle.

It's a tendency to only be able to think of an object

Det er tendensen til kun, at kunne tænke på et objekt

in terms of its traditional use or function.

ud fra dets traditionelle formål eller funktion.

And mental set is another thing. Right?

Og egen tankegang har også betydning.

That's sort of this preconceived framework

Det er sådan set den forudindtagede ramme,

with which we approach problems.

hvormed vi tilgår problemer.

And that actually makes repurposing pretty hard for all of us,

Og det gør faktisk nyorientering ret svært for os alle,

which is, I guess, why they gave a TV show to the guy who was,

hvilket formentligt er årsagen til, at de gav et helt TV-show til fyren,

like, really great at repurposing.

som var god til nyorientering.

(Laughter)

(Latter)

So the effects in both the case of iproniazid and imipramine,

Effekten af iproniazid og imipramin i begge tilfælde

they were so strong --

var så stærke,

there was mania, or people dancing in the halls.

at der opstod mani eller dans på gangene.

It's actually not that surprising they were caught.

Det er faktisk ikke overraskende at disse blev opdaget.

But it does make you wonder what else we've missed.

Men det rejser spørgsmålet om, hvad vi ellers har overset.

So iproniazid and imipramine,

Så, iproniazid og imipramin

they're more than just a case study in repurposing.

er mere end blot eksempler på nyorientering.

They have two other things in common that are really important.

De har to andre ting til fælles, som er virkelig vigtige.

One, they have terrible side effects.

Et er at de har forfærdelige bivirkninger.

That includes liver toxicity,

Det inkluderer leverforgiftning,

weight gain of over 50 pounds,

vægtforøgelser på over 25 kg,

suicidality.

selvmordstanker.

And two, they both increase levels of serotonin,

Og to, de øger begge serotonin-niveauet,

which is a chemical signal in the brain,

som er et kemisk signalstof i hjernen,

or a neurotransmitter.

eller neurotransmitter.

And those two things together, right, one or the two,

De to ting tilsammen, eller en eller to,

may not have been that important,

var måske ikke så vigtig,

but the two together meant that we had to develop safer drugs,

men de to tilsammen betød, at vi måtte udvikle sikrere medikamenter,

and that serotonin seemed like a pretty good place to start.

og serotonin virkede som et godt udgangspunkt.

So we developed drugs to more specifically focus on serotonin,

Så vi udviklede medicin som fokuserede mere på serotonin,

the selective serotonin reuptake inhibitors, so the SSRIs,

de selektive serotonin- genoptagelseshæmmere, altså SSRI'erne,

the most famous of which is Prozac.

hvoraf den mest berømte nok er Prozac.

And that was 30 years ago,

Det er 30 år siden,

and since then we have mostly just worked on optimizing those drugs.

og sidenhen har vi mest arbejdet med at optimere disse medikamenter.

And the SSRIs, they are better than the drugs that came before them,

SSRI'erne er bedre end den medicin, der kom før dem,

but they still have a lot of side effects,

men de har stadig mange bivirkninger,

including weight gain, insomnia,

inklusiv vægtforøgelse, søvnløshed,

suicidality --

selvmordstanker --

and they take a really long time to work,

og det tager utroligt lang tid før de virker,

something like four to six weeks in a lot of patients.

omkring fire til seks uger for mange patienter.

And that's in the patients where they do work.

Og det er for patienterne, hvor det virker.

There are a lot of patients where these drugs don't work.

Der er mange patienter, hvor medikamenterne ikke virker.

And that means now, in 2016,

Og det betyder, at vi i 2016

we still have no cures for any mood disorders,

stadig ingen kur har mod psykiske lidelser,

just drugs that suppress symptoms,

blot medicin der hæmmer symptomerne.

which is kind of the difference between taking a painkiller for an infection

Hvilket faktisk er forskellen mellem, at tage en smertestillende imod infektion

versus an antibiotic.

versus et antibiotikum.

A painkiller will make you feel better,

Smertestillende gør dig bedre tilpas,

but is not going to do anything to treat that underlying disease.

men behandler ikke den underliggende sygdom.

And it was this flexibility in our thinking

Det var fleksibiliteten i vores måde at tænke på,

that let us recognize that iproniazid and imipramine

der lod os anerkende, at iproniazid og imipramin

could be repurposed in this way,

kunne anvendes på en anden måde,

which led us to the serotonin hypothesis,

som ledte os til serotonin-hypotesen,

which we then, ironically, fixated on.

som vi så, ironisk nok, fastlåste os på.

This is brain signaling, serotonin,

Dette er hjernesignaler, serotonin,

from an SSRI commercial.

fra en SSRI-reklame.

In case you're not clear, this is a dramatization.

Dette en illustration.

And in science, we try and remove our bias, right,

Og i videnskaben forsøger vi at fjerne vores partiskhed

by running double-blinded experiments

ved at foretage dobbeltblindede eksperimenter.

or being statistically agnostic as to what our results will be.

eller være statistisk agnostiske overfor hvad vores resultater måtte blive.

But bias creeps in more insidiously in what we choose to study

Men partiskhed sniger sig ind i hvad, vi vælger at studere,

and how we choose to study it.

og hvordan vi vælger, at studere det.

So we've focused on serotonin now for the past 30 years,

Så vi har fokuseret på serotonin de sidste 30 år

often to the exclusion of other things.

ofte på bekostning af andre løsninger.

We still have no cures,

Vi har stadig ingen kur,

and what if serotonin isn't all there is to depression?

og hvad nu hvis serotonin ikke er det altomfattende svar på depression?

What if it's not even the key part of it?

Hvad hvis det ikke er en central del af det?

That means no matter how much time

Det betyder, at uanset hvor meget tid

or money or effort we put into it,

eller penge eller arbejde vi hælder i det,

it will never lead to a cure.

vil det aldrig lede til en kur.

In the past few years, doctors have discovered

I de senere år har lægestanden opdaget

probably what is the first truly new antidepressant since the SSRIs,

det formentlig eneste rigtigt nye antidepressivum siden SSRI'erne,

Calypsol,

Calypsol,

and this drug works very quickly, within a few hours or a day,

og det virker rigtigt hurtigt, inden for få timer eller en dag,

and it doesn't work on serotonin.

og det virker ikke på serotonin.

It works on glutamate, which is another neurotransmitter.

Den virker på glutamat, som er en anden neurotransmitter.

And it's also repurposed.

Det er også en nyorientering.

It was traditionally used as anesthesia in surgery.

Det blev oprindeligt brugt som anæstesi under operationer.

But unlike those other drugs,

Men modsat de andre medikamenter,

which were recognized pretty quickly,

som blev opdaget relativt hurtigt,

it took us 20 years

tog det os 20 år

to realize that Calypsol was an antidepressant,

for at indse at Calypsol var et antidepressivum,

despite the fact that it's actually a better antidepressant,

til trods for at det formentlig er et bedre antidepressivum

probably, than those other drugs.

end de andre typer medicin.

It's actually probably because of the fact that it's a better antidepressant

Det er angiveligt på grund af det faktum, at det er et bedre antidepressivum,

that it was harder for us to recognize.

at det var sværere for os at opdage.

There was no mania to signal its effects.

Der var ingen mani som tegn på dets effekt.

So in 2013, up at Columbia University,

I 2013, på Columbia University,

I was working with my colleague,

samarbejdede jeg med min kollega,

Dr. Christine Ann Denny,

Dr. Christine Ann Denny,

and we were studying Calypsol as an antidepressant in mice.

hvor vi studerede Calypsol som et antidepressivum på mus.

And Calypsol has, like, a really short half-life,

Calypsol har rigtigt kort halveringstid,

which means it's out of your body within a few hours.

hvilket betyder det er ude af din krop indenfor få timer.

And we were just piloting.

Dette var blot testforsøg.

So we would give an injection to mice,

Vi gav mus en indsprøjtning

and then we'd wait a week,

og ventede så en uge,

and then we'd run another experiment to save money.

for så at lave et nyt forsøg for at spare penge.

And one of the experiments I was running,

I et af de forsøg jeg foretog

we would stress the mice,

stressede vi musene

and we used that as a model of depression.

og brugte det som en simulation af depression.

And at first it kind of just looked like it didn't really work at all.

I første omgang så det slet ikke ud til at virke.

So we could have stopped there.

Så vi kunne have stoppet der.

But I have run this model of depression for years,

Men jeg har brugt denne simulation af depression i mange år,

and the data just looked kind of weird.

og dataene så mærkelige ud.

It didn't really look right to me.

Det så forkert ud for mig.

So I went back,

Så jeg startede forfra,

and we reanalyzed it

og reanalyserede dataene

based on whether or not they had gotten that one injection of Calypsol

baseret på, hvorvidt musene havde fået den ene indsprøjtning af Calypsol

a week beforehand.

ugen forinden.

And it looked kind of like this.

Og det så nogenlunde sådan ud.

So if you look at the far left,

Hvis I ser længst mod venstre,

if you put a mouse in a new space,

og hvis vi putter en mus ind i det nye rum,

this is the box, it's very exciting,

dette er boksen, det er meget spændende,

a mouse will walk around and explore,

så vil en mus krybe rundt og udforske,

and you can see that pink line is actually the measure of them walking.

og den lyserøde streg forestiller sporet, hvor musene har gået.

And we also give it another mouse in a pencil cup

Og vi gav dem en anden mus i en blyantholder,

that it can decide to interact with.

som den kan beslutte at interagere med.

This is also a dramatization, in case that's not clear.

Dette er også en dramatisering, hvis der skulle herske tvivl om det.

And a normal mouse will explore.

En normal mus vil udforske sine omgivelser,

It will be social.

være social.

Check out what's going on.

Prøv at se hvad der sker.

If you stress a mouse in this depression model,

Hvis man stresser en mus i denne depressionssimulation,

which is the middle box,

som er den midterste boks,

they aren't social, they don't explore.

er de ikke sociale, de udforsker ikke.

They mostly just kind of hide in that back corner, behind a cup.

De gemmer sig for det meste i det bageste hjørne, bag en kop.

Yet the mice that had gotten that one injection of Calypsol,

Men musene som havde fået den ene indsprøjtning af Calypsol,

here on your right,

her til højre,

they were exploring, they were social.

udforskede, og de var sociale.

They looked like they had never been stressed at all,

De så ud til aldrig at have været udsat for stress,

which is impossible.

hvilket er en umulighed.

So we could have just stopped there,

Vi kunne have valgt at stoppe dér,

but Christine had also used Calypsol before as anesthesia,

men Christine havde også brugt Calypsol som anæstesi før,

and a few years ago she had seen

og for nogle år siden, så hun,

that it seemed to have some weird effects on cells

at det lod til at have en mærkelig effekt på celler

and some other behavior

og anden adfærd,

that also seemed to last long after the drug,

som lod til at virke lang tid efter medicinens indtag,

maybe a few weeks.

til et par uger efter.

So we were like, OK,

Så vi tænkte: Okay,

maybe this is not completely impossible,

måske er det ikke en total umulighed,

but we were really skeptical.

men vi var virkelig skeptiske.

So we did what you do in science when you're not sure,

Så vi gjorde hvad man gør, når man ikke er sikker:

and we ran it again.

Vi gentog forsøgene.

And I remember being in the animal room,

Jeg kan huske at jeg var i dyre-afsnittet,

moving mice from box to box to test them,

ved at flytte mus fra boks til boks for at teste dem,

and Christine was actually sitting on the floor with the computer in her lap

og Christine sad faktisk på gulvet med sin computer i skødet,

so the mice couldn't see her,

så musene ikke kunne se hende,

and she was analyzing the data in real time.

og hun analyserede dataene i realtid.

And I remember us yelling,

Jeg kan huske, at vi råbte,

which you're not supposed to do in an animal room where you're testing,

som man faktisk ikke må i et dyre-afsnit, hvor dyrene testes,

because it had worked.

fordi det havde virket.

It seemed like these mice were protected against stress,

Det virkede som om, at musene var immune overfor stress,

or they were inappropriately happy, however you want to call it.

eller var upassende glade, eller hvordan man nu vil beskrive det.

And we were really excited.

Vi var virkelig forventningsfulde.

And then we were really skeptical, because it was too good to be true.

Og så blev vi virkelig skeptiske fordi det var for godt til at være sandt.

So we ran it again.

Så vi gjorde det igen.

And then we ran it again in a PTSD model,

Så eksperimenterede vi igen imod en PTSD-simulation,

and we ran it again in a physiological model,

og gentog det igen i en fysiologisk simulation,

where all we did was give stress hormones.

hvor vi kun uddelte stresshormoner.

And we had our undergrads run it.

Og vores studerende lavede det.

And then we had our collaborators halfway across the world in France run it.

Og så havde vi vores samarbejdspartnere i Frankrig til at gøre forsøgene.

And every time someone ran it, they confirmed the same thing.

Hver eneste gang nogen kørte forsøgene, bekræftede de det samme.

It seemed like this one injection of Calypsol

Det virkede til, at en enkelt indsprøjtning af Calypsol,

was somehow protecting against stress for weeks.

på en eller anden måde beskyttede mod stress i ugevis.

And we only published this a year ago,

Vi publicerede dette for et år siden,

but since then other labs have independently confirmed this effect.

men siden da, har andre laboratorier, uafhængigt, bekræftet denne virkning.

So we don't know what causes depression,

Vi ved ikke hvad der skyldes depression,

but we do know that stress is the initial trigger

men vi ved, at stress er den første udløser

in 80 percent of cases,

i 80 procent af tilfældene,

and depression and PTSD are different diseases,

og at depression og PTSD er forskellige sygdomme,

but this is something they share in common.

men dette har de til fælles.

Right? It is traumatic stress

Det er traumatisk stress,

like active combat or natural disasters

såsom i kampzoner, ved naturkatastrofer,

or community violence or sexual assault

vold i samfundet eller seksuelle overfald,

that causes post-traumatic stress disorder,

som udløser posttraumatisk stress syndrom,

and not everyone that is exposed to stress develops a mood disorder.

ikke alle der udsættes for stress udvikler en psykisk lidelse.

And this ability to experience stress and be resilient

Denne evne til at opleve stress, og være resilient i forhold til den,

and bounce back and not develop depression or PTSD

at komme igennem den, og ikke udvikle depression eller PTSD,

is known as stress resilience,

kendes som stress-resiliens,

and it varies between people.

og varierer fra person til person.

And we have always thought of it as just sort of this passive property.

Vi har altid tænkt på det som en passiv egenskab.

It's the absence of susceptibility factors

Det er fraværet af modtagelighed

and risk factors for these disorders.

og risikofaktorer for disse sygdomme.

But what if it were active?

Men hvad hvis det var aktiv?

Maybe we could enhance it,

Måske kunne vi forbedre det

sort of akin to putting on armor.

lidt ligesom at tage en rustning på.

We had accidentally discovered the first resilience-enhancing drug.

Vi havde ved et tilfælde opdaget det første resiliens-forbedrende stof.

And like I said, we only gave a tiny amount of the drug,

Vi indsprøjtede kun en meget lille dosis af stoffet,

and it lasted for weeks,

og det varede i ugevis,

and that's not like anything you see with antidepressants.

meget ulig hvad vi ellers ser med antidepressiva.

But it is actually kind of similar to what you see in immune vaccines.

Men det er sammenligneligt med, hvad vi ser i immunitetsvacciner.

So in immune vaccines, you'll get your shots,

Ved immunitetsvacciner får du en indsprøjtning,

and then weeks, months, years later,

og uger, måneder eller år senere,

when you're actually exposed to bacteria,

når du faktisk udsættes for bakterier,

it's not the vaccine in your body that protects you.

er det ikke vaccinen i din krop, der beskytter dig.

It's your own immune system

Det er dit eget immunsystem,

that's developed resistance and resilience to this bacteria that fights it off,

som har udviklet resistens og resiliens overfor disse bakterier, og nedkæmper dem,

and you actually never get the infection,

så du faktisk aldrig får den infektion.

which is very different from, say, our treatments. Right?

Hvilket er ganske forskelligt fra f.eks. behandlinger.

In that case, you get the infection, you're exposed to the bacteria,

I tilfælde af at du får infektionen, er du eksponeret for bakterien,

you're sick, and then you take, say, an antibiotic which cures it,

du bliver syg, og så indtager du et antibiotikum, som så kurerer det,

and those drugs are actually working to kill the bacteria.

og de stoffer arbejder faktisk på at slå bakterien ihjel.

Or similar to as I said before, with this palliative,

Som jeg sagde tidligere, med dette palliativ

you'll take something that will suppress the symptoms,

tager du noget som vil undertrykke symptomerne,

but it won't treat the underlying infection,

men som ikke behandler den underliggende infektion,

and you'll only feel better during the time in which you're taking it,

og du får det kun bedre mens du tager stoffet,

which is why you have to keep taking it.

og derfor skal man fortsætte indtaget.

And in depression and PTSD --

Ved depression og PTSD --

here we have your stress exposure --

her er din eksponering for stress --

we only have palliative care.

så har vi kun palliativ hjælp.

Antidepressants only suppress symptoms,

Antidepressiva undertrykker blot symptomer,

and that is why you basically have to keep taking them

og derfor er du nødt til, at blive ved med at tage dem

for the life of the disease,

hele sygdommens liv,

which is often the length of your own life.

som tit korrelerer med længden af dit liv.

So we're calling our resilience-enhancing drugs "paravaccines,"

Så vi kalder vore resiliens-forbedrende stoffer for "paravacciner",

which means vaccine-like,

som betyder "vaccine-lignende",

because it seems like they might have the potential

fordi det virker til at de måske har potentialet til

to protect against stress

at beskytte mod stress,

and prevent mice from developing

og forhindre mus i at udvikle

depression and post-traumatic stress disorder.

depression og posttraumatisk stress syndrom.

Also, not all antidepressants are also paravaccines.

Det er ikke alle antidepressiva, der også fungerer som paravacciner.

We tried Prozac as well,

Vi prøvede også med Prozac,

and that had no effect.

og det havde ingen effekt.

So if this were to translate into humans,

Så hvis vi skal overføre dette til mennesker,

we might be able to protect people

så er vi muligvis i stand til at beskytte folk,

who are predictably at risk

som antageligt er i fare for

against stress-induced disorders like depression and PTSD.

at udvikle stress-inducerede lidelser som depression og PTSD.

So that's first responders and firefighters,

Det er f.eks. ambulancepersonnel og brandmænd,

refugees, prisoners and prison guards,

flygtninge, indsatte i fængsler og fængselsbetjente,

soldiers, you name it.

soldater og så videre.

And to give you a sense of the scale of these diseases,

For at formidle en fornemmelse af omfanget af disse sygdomme,

in 2010, the global burden of disease

var den samlede globale byrde af sygdom i 2010

was estimated at 2.5 trillion dollars,

estimeret til 2,5 billioner dollars,

and since they are chronic,

og eftersom de er kroniske,

that cost is compounding and is therefore expected to rise

tiltager omkostningerne betragteligt, og forventes at stige

up to six trillion dollars in just the next 15 years.

til op mod seks billioner dollars alene indenfor de næste 15 år.

As I mentioned before,

Som jeg nævnte før,

repurposing can be challenging because of our prior biases.

kan nyorientering være en udfordring grundet vores forudindtagethed.

Calypsol has another name,

Calypsol har et andet navn,

ketamine,

ketamin,

which also goes by another name,

som igen kaldes noget andet,

Special K,

Special K,

which is a club drug and drug of abuse.

som er et feststof og et misbrugsstof.

It's still used across the world as an anesthetic.

Det anvendes stadig globalt som et anæstesi-præparat.

It's used in children. We use it on the battlefield.

Det anvendes til børn. Vi bruger det på slagmarker.

It's actually the drug of choice in a lot of developing nations,

Det er faktisk det foretrukne præparat i mange udviklingslande,

because it doesn't affect breathing.

fordi det ikke påvirker vejrtrækning.

It is on the World Health Organization list of most essential medicines.

Den er på WHO's liste over de mest uundværlige mediciner i verden.

If we had discovered ketamine as a paravaccine first,

Havde vi opdaget ketamin som en paravaccine først,

it'd be pretty easy for us to develop it,

havde det været let for os at udvikle stoffet yderligere,

but as is, we have to compete with our functional fixedness

men vi skal bekæmpe vores fastlåste fokus

and mental set that kind of interfere.

og vores respektive udgangspunkt.

Fortunately, it's not the only compound we have discovered

Heldigvis er det ikke det eneste medikament, vi har opdaget,

that has these prophylactic, paravaccine qualities,

som har disse profylaktiske og paravaccinale egenskaber,

but all of the other drugs we've discovered,

men alle de andre medikamenter, vi har opdaget,

or compounds if you will, they're totally new,

eller blandinger af medikamenter, er helt nye.

they have to go through the entire FDA approval process --

De skal igennem hele den medicinske godkendelsesproces --

if they make it before they can ever be used in humans.

hvis de da overhovedet bliver mulige at godkende til brug for mennesker.

And that will be years.

Og det tager årevis.

So if we wanted something sooner,

Så, hvis vi vil have noget til at ske tidligere,

ketamine is already FDA-approved.

så er ketamin allerede godkendt til medicinbrug.

It's generic, it's available.

Det er godkendt og tilgængeligt til menneskeligt forbrug.

We could develop it for a fraction of the price and a fraction of the time.

Vi kan udvikle det for en brøkdel af prisen og tiden.

But actually, beyond functional fixedness and mental set,

Men ud over fastlåst fokus, og mentalt udgangspunkt,

there's a real other challenge to repurposing drugs,

så er der en anden udfordring med at anvende medikamenter på ny,

which is policy.

som er politik.

There are no incentives in place

Der er ikke noget incitament,

once a drug is generic and off patent and no longer exclusive

når et medikament ikke er patenteret og dermed ikke længere ekslusivt

to encourage pharma companies to develop them,

for medicinalindustrien til at udvikle dem,

because they don't make money.

fordi de ikke tjener penge.

And that's not true for just ketamine. That is true for all drugs.

Det gælder ikke kun ketamin. Det gælder alle stoffer.

Regardless, the idea itself is completely novel in psychiatry,

Uanset hvad er idéen i sig selv en nyskabelse i psykiatrien,

to use drugs to prevent mental illness

at bruge medicin til at forebygge psykiske sygdomme

as opposed to just treat it.

modsat blot at behandle dem.

It is possible that 20, 50, 100 years from now,

Det er muligt, at vi om 20, 50, 100 år,

we will look back now at depression and PTSD

vil se tilbage på depression og PTSD

the way we look back at tuberculosis sanitoriums

på samme måde, som vi ser tilbage på tuberkulosesanatorier

as a thing of the past.

som et fortidslevn.

This could be the beginning of the end of the mental health epidemic.

Dette kunne være begyndelsen på enden af den psykiske lidelses epidemi.

But as a great scientist once said,

Men som en stor videnskabsmand engang sagde:

"Only a fool is sure of anything.

"Kun en tåbe er skråsikker på noget som helst.

A wise man keeps on guessing."

En vis mand bliver ved med at gætte."

Thank you, guys.

Tak skal I have.

(Applause)

(Bifald)