Could a drug prevent depression and PTSD? | Rebecca Brachman

Translator: Joseph Geni Reviewer: Joanna Pietrulewicz

Translator: Élida Tato Reviewer: Serv. de Norm. Lingüística U. de Santiago de Compostela

This is a tuberculosis ward,

Este é un pavillón de tuberculosos,

e cando se tomou a foto, a finais do século XIX,

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

one in seven of all people

unha de cada sete persoas

died from tuberculosis.

morría de tuberculose.

We had no idea what was causing this disease.

Non tiñamos nin idea de que estaba a causar esta enfermidade.

A hipótese era, de feito,

The hypothesis was actually

it was your constitution that made you susceptible.

que a nosa constitución nos facía susceptibles.

And it was a highly romanticized disease.

E foi unha enfermidade moi idealizada.

It was also called consumption,

Chamóuselle “tise”,

e era a doenza dos poetas,

and it was the disorder of poets

and artists and intellectuals.

dos artistas e dos intelectuais.

E había quen pensaba que te transportaba a unha maior sensibilidade

And some people actually thought it gave you heightened sensitivity

and conferred creative genius.

e che outorgaba un xenio creativo.

By the 1950s,

Durante a década dos 50,

we instead knew that tuberculosis was caused

sóubose que a tuberculose estaba causada

by a highly contagious bacterial infection,

por unha infección bacteriana moi contaxiosa,

which is slightly less romantic,

o que era ben menos romántico,

pero tiña a vantaxe

but that had the upside

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

de que se cadra podiamos crear medicinas para tratala.

So doctors had discovered a new drug, iproniazid,

Os médicos descubriron un novo fármaco, a iproniacida,

that they were optimistic might cure tuberculosis,

coa que tiñan esperanzas de curar a tuberculose;

así que lla deron aos pacientes,

and they gave it to patients,

and patients were elated.

e os pacientes estaban eufóricos.

They were more social, more energetic.

Estaban máis sociables, máis activos.

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

Un informe médico indicaba que eles estaban a "bailar polos corredores".

And unfortunately,

Por desgraza,

isto non significaba que estivesen mellorando.

this was not necessarily because they were getting better.

A lot of them were still dying.

Moitos estaban morrendo.

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

Outro informe médico describiuno como "indebidamente felices".

And that is how the first antidepressant was discovered.

E así foi como se descubriu o primeiro antidepresivo.

So accidental discovery is not uncommon in science,

Polo tanto, os descubrimentos accidentais non son raros na ciencia,

pero cómpre algo máis ca un feliz accidente.

but it requires more than just a happy accident.

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

Debes ser capaz de recoñecelo para poder descubrilo.

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

Como neurocientífica, vou falar un pouco

sobre a miña experiencia de primeira man

about my firsthand experience

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

con como queirades chamarlle ao contrario do puro azar,

let's call it smart luck.

podemos chamarlle azar intelixente.

But first, a bit more background.

Pero primeiro, un pouco máis de contexto.

Thankfully, since the 1950s,

Afortunadamente, dende os anos 50,

desenvolvemos outros fármacos e agora podemos curar a tuberculose.

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

E polo menos nos Estados Unidos, aínda que non necesariamente noutros países

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

we have closed our sanitoriums

pechamos os nosos sanatorios

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

e probablemente á maioría de vós non vos preocupe moito a tuberculose.

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

Pero moito do que era certo a principios do século XX.

about infectious disease,

sobre enfermidades infecciosas

we can say now about psychiatric disorders.

pódese dicir agora dos trastornos psíquicos.

We are in the middle of an epidemic of mood disorders

Estamos no medio dunha epidemia de trastornos emocionais

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

coma a depresión ou o estrés postraumático.

One in four of all adults in the United States

Un de cada catro adultos nos EE. UU.

suffers from mental illness,

sofre unha enfermidade mental,

which means that if you haven't experienced it personally

o que significa que se non a viviches en persoa

or someone in your family hasn't,

nin ninguén da túa familia a tivo,

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

é moi probable que a teña alguén que coñezas,

though they may not talk about it.

aínda que non fale dela.

Depression has actually now surpassed

A depresión superou

HIV/AIDS, malaria, diabetes and war

á sida, á malaria, á diabetes e á guerra

as the leading cause of disability worldwide.

coma primeira causa de discapacidade no mundo.

And also, like tuberculosis in the 1950s,

E tamén, coma a tuberculose nos 50,

we don't know what causes it.

non sabemos qué a provoca.

Once it's developed, it's chronic,

Unha vez que se desenvolve, é crónica,

lasts a lifetime,

dura toda a vida,

and there are no known cures.

e non hai cura coñecida.

The second antidepressant we discovered,

O segundo antidepresivo que descubrimos

also by accident, in the 1950s,

tamén por accidente, nos anos 50,

from an antihistamine that was making people manic,

a partir dun antiestamínico que estaba volvendo maníaca á xente,

imipramine.

foi a imipramina.

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

E no caso do pavillón de tuberculosos e mais no do antiestamínico,

someone had to be able to recognize

alguén se deu conta

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

de que o fármaco creado para facer unha cousa,

--tratar a tuberculose ou suprimir alerxias--

treat tuberculosis or suppress allergies --

could be used to do something very different --

podería usarse para algo moi diferente

treat depression.

--tratar a depresión.

And this sort of repurposing is actually quite challenging.

Este tipo de redeseño é bastante estimulante.

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

Cando os médicos viron por primeira vez como a iproniacida melloraba o ánimo,

they didn't really recognize what they saw.

non se decataron do que estaban vendo.

They were so used to thinking about it

Estaban tan habituados a pensar

from the framework of being a tuberculosis drug

dende o marco de que era un fármaco para a tuberculose

that they actually just listed it

que se limitaron a anotalo

as a side effect, an adverse side effect.

como un efecto secundario, un efecto secundario negativo.

As you can see here,

Como podedes ver aquí,

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

moitos deses pacientes en 1954 estaban experimentando euforia extrema.

And they were worried that this might somehow interfere

E eles estaban preocupados por se isto podería interferir dalgún xeito

with their recovering from tuberculosis.

coa súa recuperación da tuberculose.

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

Así que se recomendou que a iproniacida se empregase só en tuberculoses extremas

and in patients that were highly emotionally stable,

e en pacientes que fose moi estables emocionalmente,

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

que é o modo contrario a como se emprega un antidepresivo.

Estaban tan habituados a velo dende a perspectiva dunha soa doenza

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

they could not see the larger implications for another disease.

que non podían ver as grandes implicacións para outra distinta.

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

E sendo sinceros, non é só culpa súa.

A fixación funcional é un prexuízo que nos afecta a todos.

Functional fixedness is a bias that affects all of us.

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

É a tendencia de dar pensado nun obxecto

in terms of its traditional use or function.

só en termos da súa función tradicional.

And mental set is another thing. Right?

E o contexto mental é diferente, non si?

That's sort of this preconceived framework

É con esta especie de marco preconcibido

with which we approach problems.

con quen afrontamos os problemas.

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

E isto fainos moi complicado facer ese redeseño,

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

supoño que por iso lle deron un programa de TV a un tipo

like, really great at repurposing.

ao que se lle dá tan ben facelos.

(Laughter)

(Risas)

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

Os efectos, nos dous casos, da iproniacida e da imipramina

they were so strong --

foron tan fortes

there was mania, or people dancing in the halls.

que había maníacos, ou persoas bailando polos corredores.

It's actually not that surprising they were caught.

Non é tan sorprendente que se detectasen.

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

Pero isto fai que te preguntes qué máis pasamos por alto.

A iproniacida e a imipramina,

So iproniazid and imipramine,

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

son máis que un caso de redeseño.

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

Teñen en común outras dúas cousas moi importantes.

One, they have terrible side effects.

Primeira: terribles efectos secundarios.

That includes liver toxicity,

Entre outros, toxicidade hepática,

weight gain of over 50 pounds,

incremento de peso de preto de 25 quilos,

suicidality.

tendencias suicidas.

And two, they both increase levels of serotonin,

E segundo: os dous aumentan os niveis de serotonina,

which is a chemical signal in the brain,

que é un sinal químico no cerebro,

or a neurotransmitter.

un neurotransmisor.

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

E se collemos as cousas xuntas, --cada unha delas,

may not have been that important,

separada non é tan importante--

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

pero xuntas significaban que cumpría desenvolver fármacos máis seguros,

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

e que a serotonina parecía un bo sitio para comezar.

So we developed drugs to more specifically focus on serotonin,

Por iso, desenvolvemos fármacos que se centrasen máis na serotonina,

the selective serotonin reuptake inhibitors, so the SSRIs,

os inhibidores selectivos de recaptación da serotonina (ISRS),

the most famous of which is Prozac.

o máis famoso dos cales é o Prozac.

Diso hai 30 anos,

And that was 30 years ago,

e dende aquela viñémonos centrando en mellorar eses fármacos.

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

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

E os ISRS son mellores ca os fármacos que había antes ,

but they still have a lot of side effects,

pero aínda teñen moitos efectos secundarios:

suba de peso, insomnio,

including weight gain, insomnia,

tendencias suicidas...

suicidality --

e tardan moito en facer efecto,

and they take a really long time to work,

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

unhas catro ou seis semanas en moitos pacientes.

E iso naqueles en que funcionan.

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

Hai moitos pacientes aos que estes fármacos non lles funcionan.

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

E iso significa que agora, en 2016,

And that means now, in 2016,

we still have no cures for any mood disorders,

aínda non temos cura para ningún trastorno emocional,

just drugs that suppress symptoms,

só fármacos que suprimen síntomas,

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

o que é como se para unha infección tomamos un analxésico

versus an antibiotic.

ou un antibiótico.

A painkiller will make you feel better,

Co analxésico pódeste sentir mellor,

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

pero non vai facer nada para tratar a enfermidade subxacente.

And it was this flexibility in our thinking

E grazas a esta flexibilidade no noso pensamento

puidemos recoñecer que a iproniacida e a imipramina

that let us recognize that iproniazid and imipramine

poderían redeseñarse dese xeito,

could be repurposed in this way,

o que nos levou á hipótese da serotonina,

which led us to the serotonin hypothesis,

coa que, ironicamente, nos obsesionamos.

which we then, ironically, fixated on.

This is brain signaling, serotonin,

Estes son sinais no cerebro, serotonina,

from an SSRI commercial.

dun anuncio de ISRS.

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

Por se non está claro, isto é unha dramatización.

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

E na ciencia, intentamos eliminar os prexuízos

by running double-blinded experiments

facendo estudos de dobre cego

ou sendo estatisticamente agnósticos sobre os resultados que podemos atopar.

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

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

Pero os nesgos entran raposeiramente naquilo que decidimos estudar

and how we choose to study it.

e en como decidimos estudalo.

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

E así, nos últimos 30 anos, centrámonos na serotonina,

often to the exclusion of other things.

excluíndo con frecuencia outros elementos.

We still have no cures,

Seguimos sen ter cura.

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

E se a serotonina non fose o único factor da depresión?

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

E se nin sequera fose unha parte esencial?

That means no matter how much time

Isto significa que tanto ten o tempo

or money or effort we put into it,

os cartos ou o esforzo que lle adiquemos,

it will never lead to a cure.

nunca nos levará a unha cura.

Nos últimos anos, os médicos descubriron o que probablemente é

In the past few years, doctors have discovered

o primeiro antidepresivo real dende os inhibidores de recaptación da serotonina,

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

Calypsol,

o Calipsol,

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

e este fármaco funciona moi rápido, nunhas poucas horas ou un día,

and it doesn't work on serotonin.

e non se basea en serotonina.

It works on glutamate, which is another neurotransmitter.

Faino no glutamato, outro neurotransmisor.

And it's also repurposed.

E tamén tiña outra función.

It was traditionally used as anesthesia in surgery.

Tradicionalmente empregábase coma anestesia en operacións.

But unlike those other drugs,

Pero ao revés cós fármacos anteriores

which were recognized pretty quickly,

que se identificaron bastante axiña,

levou 20 anos darse conta

it took us 20 years

to realize that Calypsol was an antidepressant,

de que o Calipsol era un antidepresivo,

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

a pesar de ser, en realidade, un antidepresivo mellor

probably, than those other drugs.

ca a maioría dos outros fármacos.

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

E probablemente, por ser un antidepresivo mellor

custounos máis recoñecelo.

that it was harder for us to recognize.

Non había loucura que amosase os seus efectos.

There was no mania to signal its effects.

So in 2013, up at Columbia University,

En 2013, na Universidade de Columbia,

I was working with my colleague,

estaba a traballar coa miña colega,

Dr. Christine Ann Denny,

a dra. Christine Ann Denny,

and we were studying Calypsol as an antidepressant in mice.

estabamos estudando o Calipsol como un antidepresivo en ratos.

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

O Calipsol ten unha vida media moi curta,

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

o que significa que permanece no corpo só unhas poucas horas.

And we were just piloting.

Estábamos facendo probas piloto.

Poñeriámoslle unha inxección aos ratos,

So we would give an injection to mice,

and then we'd wait a week,

e esperariamos unha semana,

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

e despois fariamos outro experimento para poder aforrar cartos.

E nun dos meus experimentos

And one of the experiments I was running,

we would stress the mice,

estresabamos aos ratos,

and we used that as a model of depression.

e usabamos isto como un modelo de depresión.

Ao comezo parecía que non funcionaba en absoluto.

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

So we could have stopped there.

Puidemos parar nese momento.

But I have run this model of depression for years,

Pero usei este modelo de depresión durante moitos anos,

and the data just looked kind of weird.

e os resultados parecían estraños.

It didn't really look right to me.

Parecíame que estaban mal.

So I went back,

Volvín atrás,

and we reanalyzed it

o e reanaliceinos

baseándome en se recibiran ou non unha inxección de Calipsol

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

a week beforehand.

a semana anterior.

And it looked kind of like this.

E eran algo coma isto.

So if you look at the far left,

Se mirades á esquerda,

se poñedes un rato nun novo espazo,

if you put a mouse in a new space,

this is the box, it's very exciting,

a caixa neste caso, é moi emocionante,

a mouse will walk around and explore,

o rato camiñará e explorará a contorna

e pódese ver a liña rosa, que á a medida do que camiñan.

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

And we also give it another mouse in a pencil cup

Tamén puxemos outro rato nun gobelete

that it can decide to interact with.

co que podía decidir interaccionar.

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

Isto tamén é unha dramatización, por se non está claro.

And a normal mouse will explore.

Un rato normal explorará.

It will be social.

Será sociable.

Check out what's going on.

Mirade o que está a pasar.

Se estresas un rato neste modelo de depresión,

If you stress a mouse in this depression model,

which is the middle box,

que é a caixa do medio,

non son sociables, non exploran.

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

Eles, sobre todo, escóndense nesa esquina, detrás do gobelete.

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

Porén, os ratos que recibiron a inxección de Calipsol,

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

védelo á vosa dereita,

here on your right,

estaban explorando, eran sociables.

they were exploring, they were social.

They looked like they had never been stressed at all,

Parecía coma se nunca antes estiveran estresados,

o que era imposible.

which is impossible.

So we could have just stopped there,

Poderíamos parar aquí,

but Christine had also used Calypsol before as anesthesia,

pero Christine tamén usara antes Calipsol como anestesia,

e había uns anos que detectara

and a few years ago she had seen

that it seemed to have some weird effects on cells

que parecía ter algúns efectos estraños nas células

e nalgún outro comportamento

and some other behavior

that also seemed to last long after the drug,

que tamén parecía manterse moito despois de tomar o fármaco,

maybe a few weeks.

se cadra, unhas poucas semanas.

So we were like, OK,

Así que nos dixemos,

maybe this is not completely impossible,

ao mellor isto non é de todo imposible”,

pero eramos moi escépticas.

but we were really skeptical.

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

E fixemos o que se fai en ciencia cando un non está seguro:

and we ran it again.

intentámolo outra vez.

And I remember being in the animal room,

Lembro de estar no cuarto dos animais,

moving mice from box to box to test them,

movendo ratos dunha caixa á outra para analizalos,

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

e Christine estaba sentada no chan co ordenador no colo

so the mice couldn't see her,

para que os ratos non a visen,

and she was analyzing the data in real time.

e ela estaba analizando os datos en tempo real.

And I remember us yelling,

Recordo que berramos,

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

algo que non debes facer nunha sala con animais que estás analizando,

because it had worked.

porque funcionou.

It seemed like these mice were protected against stress,

Parecía coma se estes ratos estivesen protexidos contra o estrés,

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

ou estaban indebidamente felices, coma lle queirades chamar.

And we were really excited.

E estabamos moi emocionadas.

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

E despois eramos realmente escépticas, porque era demasiado bo para ser certo.

So we ran it again.

Así que volvémolo probar.

And then we ran it again in a PTSD model,

Volvemos probalo nun modelo de estrés postraumático,

and we ran it again in a physiological model,

e outra vez nun modelo fisiolóxico,

where all we did was give stress hormones.

onde só lles demos hormonas do estrés.

And we had our undergrads run it.

Tiñamos estudantes facendo probas.

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

E tamén os nosos colaboradores do outro lado do mundo, en Francia.

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

E cada vez que alguén facía probas confirmábanos o mesmo.

Parecía que esta inxección de Calipsol

It seemed like this one injection of Calypsol

was somehow protecting against stress for weeks.

dalgunha maneira protexía do estrés durante semanas.

And we only published this a year ago,

Publicamos isto hai só un ano,

pero dende aquela outros laboratorios confirmaron este efecto independentemente.

but since then other labs have independently confirmed this effect.

So we don't know what causes depression,

Non sabemos qué causa a depresión,

but we do know that stress is the initial trigger

pero si que o estrés é a causa inicial

in 80 percent of cases,

no 80 por cento dos casos,

e a depresión e o estrés postraumático son doenzas distintas,

and depression and PTSD are different diseases,

but this is something they share in common.

pero isto é algo que comparten.

Right? It is traumatic stress

O estrés traumático,

like active combat or natural disasters

coma un combate ou un desastre natural

or community violence or sexual assault

ou violencia nas comunidades ou unha agresión sexual

que causa trastorno por estrés postraumático,

that causes post-traumatic stress disorder,

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

e non todo o mundo exposto ao estrés desenvolve un trastorno emocional.

And this ability to experience stress and be resilient

E esta capacidade de sentir estrés e resistilo

and bounce back and not develop depression or PTSD

e recuperarse e non desenvolver depresión ou estrés postraumático

is known as stress resilience,

coñécese como resistencia ó estrés,

and it varies between people.

e varía de persoa a persoa.

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

Sempre pensamos que se trataba dun tipo de capacidade pasiva.

Non hai factores de susceptibilidade

It's the absence of susceptibility factors

and risk factors for these disorders.

nin factores de risco para estes trastornos.

But what if it were active?

Pero e se fose unha capacidade activa?

Maybe we could enhance it,

Se cadra, poderiamos mellorala,

sort of akin to putting on armor.

algo así como poñer unha armadura.

We had accidentally discovered the first resilience-enhancing drug.

Descubrimos accidentalmente o primeiro fármaco que mellora a resistencia.

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

E como dixen, só administramos unha pequena cantidade de fármaco

and it lasted for weeks,

e o efecto durou semanas,

algo que non se parece en nada ao que vemos cos antidepresivos.

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

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

Parécese máis ao que pasa coas vacinas.

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

Coas vacinas, pos unha inxección,

e durante semanas, meses ou anos,

and then weeks, months, years later,

when you're actually exposed to bacteria,

cando te expós á bacteria

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

non é a vacina do teu corpo quen te protexe,

It's your own immune system

é o teu propio sistema inmunolóxico

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

que desenvolveu resistencia e resiliencia contra esta bacteria e pode combatela,

and you actually never get the infection,

e ti non colles a infección,

o que é moi distinto a tratar a infección, non si?

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

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

Neste segundo caso, colles a infección, exposte á bacteria,

enfermas, e despois tomas un antibiótico que a cura,

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

and those drugs are actually working to kill the bacteria.

e eses fármacos traballan para eliminar a bacteria.

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

Nin se parece ao que comentei antes, dos fármacos paliativos,

you'll take something that will suppress the symptoms,

tomarás algo que eliminará os síntomas,

but it won't treat the underlying infection,

pero non tratará a infección subxacente,

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

e tan só te atoparás mellor mentres esteas tomando o fármaco,

which is why you have to keep taking it.

por iso tes que seguir tomándoo.

And in depression and PTSD --

E para a depresión e o estrés postraumático

here we have your stress exposure --

--velaquí temos a exposición ao estrés--

we only have palliative care.

só temos tratamentos paliativos.

Antidepressants only suppress symptoms,

Os antidepresivos só eliminan os síntomas,

e esa é basicamente a razón pola cal hai que seguir tomándoos

and that is why you basically have to keep taking them

for the life of the disease,

durante a duración da enfermidade,

which is often the length of your own life.

que é, con frecuencia, a da propia vida.

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

Por iso lles chamamos aos nosos fármacos que melloran a resistencia “paravacinas”,

which means vaccine-like,

que significa "coma unha vacina"

because it seems like they might have the potential

porque parece que tivesen o potencial

to protect against stress

de protexernos contra o estrés

e previr que os ratos desenvolvan

and prevent mice from developing

depression and post-traumatic stress disorder.

depresión e estrés postraumático.

Also, not all antidepressants are also paravaccines.

Non todos os antidepresivos son paravacinas.

We tried Prozac as well,

Tamén probamos co Prozac,

and that had no effect.

e non tivo efecto ningún.

Se isto se trasladase aos seres humanos

So if this were to translate into humans,

poderíamos protexer á xente

we might be able to protect people

who are predictably at risk

que está potencialmente en perigo

against stress-induced disorders like depression and PTSD.

de trastornos provocados polo estrés

coma a depresión ou o estrés postraumático.

So that's first responders and firefighters,

Persoas como traballadores de primeiros auxilios e bombeiros,

refuxiados, reclusos e funcionarios de prisións,

refugees, prisoners and prison guards,

soldiers, you name it.

soldados, por citar algúns.

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

Para darvos unha idea da magnitude deste tipo de enfermidades,

in 2010, the global burden of disease

en 2010, a carga global destas doenzas

was estimated at 2.5 trillion dollars,

estimouse en 2,5 billóns de dólares

e como son crónicas,

and since they are chronic,

that cost is compounding and is therefore expected to rise

o custo é acumulativo polo que se prevé que medre

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

en seis billóns de dólares só nos próximos 15 anos.

As I mentioned before,

Como mencionei antes,

redeseñar un fármaco pode ser complexo por causa dos nosos nesgos previos.

repurposing can be challenging because of our prior biases.

Calypsol has another name,

O calipsol ten outro nome,

ketamina,

ketamine,

which also goes by another name,

que tamén é coñecida como

Special K,

Special K,

which is a club drug and drug of abuse.

unha droga de deseño e un estupefaciente.

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

Aínda se emprega ao redor do mundo como anestésico.

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

Emprégase en nenos. Empregámola nos campos de batalla.

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

De feito é o fármaco elixido en moitos países en desenvolvemento

because it doesn't affect breathing.

porque non afecta á respiración.

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

Está na lista de fármacos esenciais da Organización Mundial da Saúde.

If we had discovered ketamine as a paravaccine first,

Se descubrísemos a ketamina primeiro com unha paravacina,

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

sería bastante doado desenvolvérmola,

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

pero temos que competir contra a fixación funcional

and mental set that kind of interfere.

e os construtos mentais que interfiren.

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

Por sorte, non é o único composto que descubrimos

that has these prophylactic, paravaccine qualities,

con esas calidades profilácticas e paravacinais,

but all of the other drugs we've discovered,

pero os outros fármacos que atopamos,

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

ou compostos se prefiren, son totalmente novos,

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

teñen que superar o proceso completo de aceptación da FDA

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

antes de poder usarse en seres humanos.

And that will be years.

E iso vai supoñer anos.

So if we wanted something sooner,

Se queremos algo máis axiña,

ketamine is already FDA-approved.

a ketamina xa está aprobada pola FDA.

It's generic, it's available.

É xenérica, está dispoñible.

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

Podería desenvolverse pola metade de prezo e de tempo.

But actually, beyond functional fixedness and mental set,

Pero, máis alá da fixación funcional e o construto mental,

there's a real other challenge to repurposing drugs,

hai outro desafío para o redeseño de fármacos:

which is policy.

as políticas.

Non existen incentivos

There are no incentives in place

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

--se o fármaco é xenérico e sen patente e non existe unha exclusividade--

que animen ás farmacéuticas a desenvolvelos,

to encourage pharma companies to develop them,

because they don't make money.

porque non gañan cartos.

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

Isto non só é certo para a ketamina. Éo para todos os fármacos.

Regardless, the idea itself is completely novel in psychiatry,

De todos os xeitos, a propia idea é totalmente novidosa en psiquiatría,

to use drugs to prevent mental illness

usar drogas para previr enfermidades mentais

as opposed to just treat it.

no canto de tratalas.

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

É posible que en 20, 50, ou 100 anos

we will look back now at depression and PTSD

miremos a depresión e o estrés postraumático

the way we look back at tuberculosis sanitoriums

como miramos hoxe os sanatorios de tuberculosos,

as a thing of the past.

como cousas do pasado.

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

Isto podería ser o principio da fin dunha epidemia de saúde mental.

But as a great scientist once said,

Pero como un gran científico dixo,

"Only a fool is sure of anything.

" Só un tolo está seguro de algo,

A wise man keeps on guessing."

o sabio segue intentando adiviñar."

[MacGyver]

Thank you, guys.

Grazas.

(Applause)

(Aplausos)