Could a drug prevent depression and PTSD? | Rebecca Brachman

Translator: Joseph Geni Reviewer: Joanna Pietrulewicz

翻译人员: Hong Zhang 校对人员: Jiawei Ni

这是一个肺结核病房，

This is a tuberculosis ward,

在十九世纪末

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

one in seven of all people

每七个人中就有一个

died from tuberculosis.

死于肺结核。

We had no idea what was causing this disease.

我们不清楚这个病的起因。

我们猜想

The hypothesis was actually

it was your constitution that made you susceptible.

可能是我们的体质决定了我们的易感染性。

And it was a highly romanticized disease.

而且这种病被披上了浪漫滴外衣。

It was also called consumption,

被称为痨病。

它是诗人，

and it was the disorder of poets

and artists and intellectuals.

艺术家，智者得的病。

有些人甚至认为这种病让你变得更敏感，

And some people actually thought it gave you heightened sensitivity

and conferred creative genius.

并且赋予你天才的特质。

By the 1950s,

到二十世纪五十年代，

we instead knew that tuberculosis was caused

我们发现肺结核是由

by a highly contagious bacterial infection,

一种传染性很强的细菌感染引起的，

which is slightly less romantic,

并没有那么浪漫，

然而这

but that had the upside

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

让我们想到研发药物来治疗这种疾病的可能性。

So doctors had discovered a new drug, iproniazid,

于是医生们发现了一种新药－异丙嗪，

that they were optimistic might cure tuberculosis,

他们乐观地认为可以治愈肺结核，

他们把这种药给病人服用，

and they gave it to patients,

and patients were elated.

病人们很兴奋。

They were more social, more energetic.

他们变得更活跃，充满生机。

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

一项医学报告提到，他们“ 在走廊手舞足蹈。“

And unfortunately,

可惜的是

这并不意味着他们在康复。

this was not necessarily because they were getting better.

A lot of them were still dying.

很多病人依然频临死亡。

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

另外有一份医学报告称他们“不正常得开心”

And that is how the first antidepressant was discovered.

第一种抗抑郁药物就这样发明了。

So accidental discovery is not uncommon in science,

这种巧合在科学领域并不多见，

但是它需要的不仅仅是开心的巧合。

but it requires more than just a happy accident.

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

你需要有能力在这种巧合发生的时候抓住它。

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

作为一个神经学家，让我与你分享一些

about my firsthand experience

我的第一手经验

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

你可能会称之为狗屎运，

let's call it smart luck.

我更倾向于称之为聪明的运气。

But first, a bit more background.

首先，说说背景知识。

Thankfully, since the 1950s,

自二十世纪五十年代，

我们研发了其他药物，我们现在事实上已经可以治愈肺结核。

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

至少在美国是这样。

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

we have closed our sanitoriums

我们关闭了疗养院

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

而且可能你们大部分人已经不是那么担心肺结核。

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

可是在二十世纪初我们对于

about infectious disease,

传染病的担心，

we can say now about psychiatric disorders.

和当今的精神病类似。

We are in the middle of an epidemic of mood disorders

我们正陷于情绪困扰之中

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

比如抑郁症和创后应激障碍，PTSD。

One in four of all adults in the United States

在美国，每四个人中就有一个

suffers from mental illness,

受精神疾病的困扰，

which means that if you haven't experienced it personally

也就是说即使你可能本身没有，

or someone in your family hasn't,

或者你的家人没有，

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

可是很有可能你认识的人有，

though they may not talk about it.

只是他们不说而已。

Depression has actually now surpassed

抑郁症实际上已经超越了

HIV/AIDS, malaria, diabetes and war

艾滋病，疟疾，糖尿病和战争

as the leading cause of disability worldwide.

成为全球范围健康的头号杀手。

And also, like tuberculosis in the 1950s,

就像二十世纪五十年代时的肺结核一样，

we don't know what causes it.

我们不清楚它的起因。

Once it's developed, it's chronic,

一旦发病，就是慢性

lasts a lifetime,

会伴随你一生，

and there are no known cures.

而且目前无法治愈。

The second antidepressant we discovered,

第二种抗抑郁药同样

also by accident, in the 1950s,

偶然发现于二十世纪五十年代，

from an antihistamine that was making people manic,

是从让人躁狂的抗组胺药中发现的，

imipramine.

丙咪嗪。

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

无论是在结核病还是抗组胺药的个案中，

someone had to be able to recognize

都需要有人发现

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

一种本来用于治疗一种病的药物

治疗结核或者抗过敏

treat tuberculosis or suppress allergies --

could be used to do something very different --

都可以用于完全不同的治疗－

treat depression.

治疗抑郁症。

And this sort of repurposing is actually quite challenging.

这种改变事实上非常具有挑战性。

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

当医生们最早看到异丙嗪情绪提升的作用时，

they didn't really recognize what they saw.

他们并没有意识到他们看到的是什么。

They were so used to thinking about it

他们总是习惯性地从

from the framework of being a tuberculosis drug

治疗肺结核的药物

that they actually just listed it

的副作用

as a side effect, an adverse side effect.

不良的副作用来考虑。

As you can see here,

基于这个原因，

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

在1954 年许多病人表现出异常的快乐。

And they were worried that this might somehow interfere

于是医生们担心这种状态会影响病人

with their recovering from tuberculosis.

肺结核的治疗。

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

于是他们建议异丙嗪只可以用于严重的结核病患者

and in patients that were highly emotionally stable,

以及心理状态非常稳定的病人，

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

这显然和我们治疗抑郁病患者截然相反。

他们太过习惯于只关注一个病的状况，

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.

而未能从另一个疾病的角度看到药物更广的适用。

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

公正地说，这不全是他们的错。

我们可能都受着教条主义的影响，

Functional fixedness is a bias that affects all of us.

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

我们倾向于只考虑一个事物

in terms of its traditional use or function.

传统意义上的使用和功能。

And mental set is another thing. Right?

而且思维方式是另一回事。 对吗？

That's sort of this preconceived framework

这种

with which we approach problems.

我们用于思考的思维定式

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

使得发散思考变得相当困难，

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

也就是，我想，为什么电视节目亲赖于那些

like, really great at repurposing.

善于发散性思维的人们。

(Laughter)

（笑声）

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

所以，在这两个例子中，异丙嗪和丙咪嗪

they were so strong --

药效都很强－

there was mania, or people dancing in the halls.

狂躁或是人们在走廊跳舞。

It's actually not that surprising they were caught.

他们被注意到并不奇怪。

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

那么你会否想到我们是否还忽视了其他东西。

所以异丙嗪和丙咪嗪

So iproniazid and imipramine,

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

他们不仅仅是发散思维的一个案例，

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

他们有其他两样重要的共性，

One, they have terrible side effects.

其一， 他们有很强的副作用

That includes liver toxicity,

包括肝中毒，

weight gain of over 50 pounds,

体重增加超过50 磅，

suicidality.

自杀倾向。

And two, they both increase levels of serotonin,

第二， 他们都增加了血清素的指标

which is a chemical signal in the brain,

大脑中的一个化学信号，

or a neurotransmitter.

或者神经传递组织。

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

这两个副作用一起，对，第一个或者第二个

may not have been that important,

可能不是那么重要，

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

但是两者合并意味着我们必须开发更安全的药物

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

而且血清素似乎是个好的突破口。

So we developed drugs to more specifically focus on serotonin,

于是我们研制了专注于血清素的药物，

the selective serotonin reuptake inhibitors, so the SSRIs,

选择性5-羟色胺再摄取抑制剂， SSRIs，

the most famous of which is Prozac.

最有名的就是Prozac。

那是30 年前，

And that was 30 years ago,

从那时起我们致力于优化这些药物。

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,

SSRI类药物比以前的药物都好，

but they still have a lot of side effects,

但是他们也还有副作用，

包括体重增加，失眠，

including weight gain, insomnia,

自杀倾向－

suicidality --

而且药效产生慢，

and they take a really long time to work,

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

有些患者需要4到6个星期才见效。

这是在那些药物产生疗效的患者中。

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

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

也有许多患者对药物没有反应。

也就是说，现在，在2016年，

And that means now, in 2016,

we still have no cures for any mood disorders,

我们依然没有治愈情绪障碍的药物，

just drugs that suppress symptoms,

只有抑制症状的药物，

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

就好像治疗感染的时候，止痛药和

versus an antibiotic.

抗菌素的区别。

A painkiller will make you feel better,

止痛药让你感觉好些，

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

但不能治愈引起痛症的病。

And it was this flexibility in our thinking

是我们思维的灵活性

让我们发现 了异丙嗪和丙咪嗪

that let us recognize that iproniazid and imipramine

可以用作其他用途，

could be repurposed in this way,

引领我们走向血清素，

which led us to the serotonin hypothesis,

然后我们专注于

which we then, ironically, fixated on.

This is brain signaling, serotonin,

大脑的信号，血清素

from an SSRI commercial.

一种SSRI药物

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

如果你不清楚的话，这是图示。

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

在科学领域，我们尽可能排除偏见，是吧？

by running double-blinded experiments

通过双盲试验

或者对我们的试验数据持中立的态度。

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

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

但是偏见却悄悄地渗入到我们研究的课题

and how we choose to study it.

以及我们选择的研究方法。

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

所以在过去30年我们潜心于血清素的同时，

often to the exclusion of other things.

也排除了其他的事物。

We still have no cures,

我们依然没有根治的方法。

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

假如血清素不是抑郁的全部？

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

或者如果它根本不是抑郁的核心？

That means no matter how much time

那就意味着无论我们花多少时间

or money or effort we put into it,

或是金钱，或是努力，

it will never lead to a cure.

我们永远找不到治愈的办法。

In the past few years, doctors have discovered

在过去的几年，医生们发现了

自从SSRI以来的第一种新抗抑郁药

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

Calypsol,

Calypsol

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

而且这种药见效快，只需几个小时或者一天。

and it doesn't work on serotonin.

而且它不影响血清素。

It works on glutamate, which is another neurotransmitter.

它作用于谷氨酸，另一种神经传感器。

And it's also repurposed.

这也是一个重新定位的例子。

It was traditionally used as anesthesia in surgery.

这种药传统上是用于手术中的麻醉剂。

But unlike those other drugs,

不像其他的药物，

which were recognized pretty quickly,

很快就得到认同，

人们用了20 年

it took us 20 years

to realize that Calypsol was an antidepressant,

才意识到 Calypsol 是一种抗抑郁药物。

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

尽管事实上

probably, than those other drugs.

它可能比其他的药物都更有效。

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

事实上有可能正因为它是一种更有效的抗抑郁药

所以才更难以被大家认识。

that it was harder for us to recognize.

没有狂躁来凸显它的副作用。

There was no mania to signal its effects.

So in 2013, up at Columbia University,

所以在2013年， 在哥伦比亚大学，

I was working with my colleague,

我在和我的同事

Dr. Christine Ann Denny,

Christine Ann Denny 博士工作

and we were studying Calypsol as an antidepressant in mice.

我们在研究Calypsol作为抗抑郁药物在老鼠身上的反应。

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

Calypsol的半衰期很短，

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

就是说它在几小时内就会被排出体外。

And we were just piloting.

我们只是在试验，

所以我们会给老鼠注射

So we would give an injection to mice,

and then we'd wait a week,

我们然后等一个星期，

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

然后我们为了省钱会再进行另一个试验。

在我的一个试验中，

And one of the experiments I was running,

we would stress the mice,

我们会给老鼠们施加压力，

and we used that as a model of depression.

我们把这当作一个抑郁样本。

起初看起来好像根本没什么作用

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

So we could have stopped there.

所以我们本应该停止。

But I have run this model of depression for years,

但是我做这个抑郁试验多年，

and the data just looked kind of weird.

收集到的数据有些怪。

It didn't really look right to me.

反正就是看起来不对。

So I went back,

于是我回去，

and we reanalyzed it

重新分析

根据它们是否被注射 Calypsol

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

a week beforehand.

一星期前

And it looked kind of like this.

数据是这样的

So if you look at the far left,

如果你看最左边，

如果你把一只老鼠放在一个新环境

if you put a mouse in a new space,

this is the box, it's very exciting,

这是那个盒子，它很兴奋，

a mouse will walk around and explore,

老鼠会到处走来走去。

你看到的粉色线时它们走动的记录

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

我们还给它提供了另外一只装在笔盒里的老鼠

that it can decide to interact with.

如果它愿意，可以和它交流。

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

这也是一个图示，让大家看得更清楚。

And a normal mouse will explore.

一个正常的老鼠会探索。

It will be social.

会社交。

Check out what's going on.

查看周围在发生什么。

如果你给老鼠压力，让它抑郁，

If you stress a mouse in this depression model,

which is the middle box,

像中间的这个盒子，

它们不会社交，不会探索，

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

多数时间它们会躲在杯子后面角落。

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

然而那些注射了一针Calypsol的老鼠

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

在右边

here on your right,

它们在探索，在交流。

they were exploring, they were social.

They looked like they had never been stressed at all,

它们看上去似乎从未被抑郁

不可思议。

which is impossible.

So we could have just stopped there,

我们本可以就此打住，

but Christine had also used Calypsol before as anesthesia,

但是Christine曾经使用过Calypsol 做为麻醉药物，

几年前她曾经看到

and a few years ago she had seen

that it seemed to have some weird effects on cells

它似乎对细胞有些奇怪的作用

而且一些其他行为

and some other behavior

that also seemed to last long after the drug,

似乎在用药之后持续很久，

maybe a few weeks.

可能有几个星期。

So we were like, OK,

于是我们觉得，好的，

maybe this is not completely impossible,

也许这不是完全不可能。

但是我们也充满疑惑。

but we were really skeptical.

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

于是我们做了在科学上当你疑惑的时候该做的事，

and we ran it again.

再次试验。

And I remember being in the animal room,

我记得在动物房

moving mice from box to box to test them,

把老鼠从一个盒子放到另一个盒子来试验它们，

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

Christine 就坐在地上， 腿上放着她的手提电脑，

so the mice couldn't see her,

这样老鼠就看不到她。

and she was analyzing the data in real time.

她在做实地数据分析。

And I remember us yelling,

我记得我们大叫，

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

（当然不应该在做测试的动物房这样做）

because it had worked.

因为我们成功了。

It seemed like these mice were protected against stress,

似乎这些老鼠受到了能够对抗压力的保护，

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

或者说他们不适当地快乐，你怎么形容都好。

And we were really excited.

我们非常激动。

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

然后我们变得很疑惑因为这个结果好得令人难以置信。

So we ran it again.

于是我们又做了一次试验。

And then we ran it again in a PTSD model,

我们又做了一次，不过是用 PTSD 模式

and we ran it again in a physiological model,

然后我们又做了一次心理试验模式

where all we did was give stress hormones.

我们给他们压力荷尔蒙

And we had our undergrads run it.

我们让本科生做的实验

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

然后我们让在法国的合作者实验

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

每一次的试验都验证了同样的结果。

似乎一剂 Calypsol 的注射

It seemed like this one injection of Calypsol

was somehow protecting against stress for weeks.

可以防止压力过量几个星期。

And we only published this a year ago,

一年前我们发表了这个，

从那时起其他的实验室独立验证了这项效果

but since then other labs have independently confirmed this effect.

So we don't know what causes depression,

所以我们不知道抑郁的本源，

but we do know that stress is the initial trigger

但是我们知道压力是诱因

in 80 percent of cases,

百分之八十的个案中，

and depression and PTSD are different diseases,

抑郁和创伤后应激障碍是不同的疾病，

but this is something they share in common.

但是他们有共性

Right? It is traumatic stress

对吧？那就是强大的压力

like active combat or natural disasters

就像剧烈的战斗或者自然灾害

or community violence or sexual assault

或者社区暴力，性侵

都会引起创伤后应激障碍，

that causes post-traumatic stress disorder,

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

但是不是每个经历过刺激的人都会产生情绪障碍。

And this ability to experience stress and be resilient

这种经历创伤但能恢复

and bounce back and not develop depression or PTSD

而且不形成抑郁或创伤后应激障碍

is known as stress resilience,

就是我们说的抗压恢复能力。

and it varies between people.

这种能力每个人都不一样。

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

我们一直以为它是一种负面因素

是缺乏敏感因素

It's the absence of susceptibility factors

and risk factors for these disorders.

以及这些心理障碍的风险因素

But what if it were active?

但是如果它是活性的，

Maybe we could enhance it,

也许我们可以加强它

sort of akin to putting on armor.

好像给它戴上盔甲。

We had accidentally discovered the first resilience-enhancing drug.

我们碰巧发现了第一种提高抗压力的药物。

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

像我说的那样，我们只给了很小剂量的药物，

and it lasted for weeks,

药效持续了几个星期，

这不是你所了解的抗抑郁药物。

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

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

但是它却像是接种疫苗

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

如果你接种了疫苗，

那么几周，几个月，几年后，

and then weeks, months, years later,

when you're actually exposed to bacteria,

当你接触细菌的时候

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

不是你身体里的疫苗在保护你，

It's your own immune system

是你自身的免疫系统

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

已经产生了对这种细菌的抗体在对抗细菌

and you actually never get the infection,

而你从未真正被感染过。

这和我们的治疗不同，是吧？

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

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

在那种情况下，你接种，接触细菌，

你生病，然后你吃抗生素来治疗

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

and those drugs are actually working to kill the bacteria.

而那些药物实际上杀死了细菌

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

或者像我以前所说的，使用这种姑息治疗，

you'll take something that will suppress the symptoms,

你服用药物掩盖病症，

but it won't treat the underlying infection,

而不能治愈引起病痛的源头

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

在你用药的时候你觉得好些，

which is why you have to keep taking it.

于是你不得不持续用药。

And in depression and PTSD --

对于抑郁和创伤后应激障碍

here we have your stress exposure --

我们看到你的焦虑

we only have palliative care.

我们只能保守治疗，

Antidepressants only suppress symptoms,

抗抑郁药只能缓解症状，

所以你得不停地使用药物

and that is why you basically have to keep taking them

for the life of the disease,

在你整个患病阶段

which is often the length of your own life.

通常会是你的一生。

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

所以我们把提升恢复能力的药叫做类疫苗

which means vaccine-like,

意思是和疫苗相似

because it seems like they might have the potential

因为它似乎有

to protect against stress

抗焦虑的潜质

防止老鼠患上

and prevent mice from developing

depression and post-traumatic stress disorder.

抑郁症和创伤后应激障碍症。

Also, not all antidepressants are also paravaccines.

而且，不是所有的抗抑郁药物都是疫苗类的。

We tried Prozac as well,

我们尝试过Prozac，

and that had no effect.

没有效果。

所以如果用于人类的话，

So if this were to translate into humans,

我们可能可以保护那些

we might be able to protect people

who are predictably at risk

高危人群

against stress-induced disorders like depression and PTSD.

免受焦虑引起的心理疾病的困扰， 比如抑郁症和创伤后应激障碍症。

So that's first responders and firefighters,

也就是第一反应者，消防员，

难民，罪犯，监管人员

refugees, prisoners and prison guards,

soldiers, you name it.

士兵，等等。

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

让我们了解一下这些疾病的数据

in 2010, the global burden of disease

在2010年，全球疾病负担

was estimated at 2.5 trillion dollars,

大约2.5万亿

由于它们是慢性病

and since they are chronic,

that cost is compounding and is therefore expected to rise

这个花销还要复加，所以预期会

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

在未来15 年内上升到6万亿元。

As I mentioned before,

我前面提到过

基于我们的偏见，发散思维具有挑战性

repurposing can be challenging because of our prior biases.

Calypsol has another name,

Calypsol 有另一个名字

氯胺酮

ketamine,

which also goes by another name,

也称作

Special K,

K 仔

which is a club drug and drug of abuse.

是一种在夜总会可以见到的被滥用的药物。

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

它还在全世界被用作麻醉剂。

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

它被用于儿童。我们在战场使用。

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

在很多国家属于非处方药物

because it doesn't affect breathing.

因为它不会影响呼吸。

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

在世界卫生组织被列为必要药物。

If we had discovered ketamine as a paravaccine first,

如果我们早些发现氯胺酮可以用作疫苗

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

那我们就可以把他研发成疫苗

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

可是，我们不得不对抗我们的功能固定性

and mental set that kind of interfere.

以及教条思维

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

幸运的是，这不是我们发现的唯一

that has these prophylactic, paravaccine qualities,

具有疫苗潜质的药物。

but all of the other drugs we've discovered,

但是所有其他我们发现的药物

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

都很新

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

它们不得不通过整个药物与食品审批过程

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

在他们可以在人身上使用之前

And that will be years.

我们得等许多年。

So if we wanted something sooner,

所以如果我们早些

ketamine is already FDA-approved.

氯胺酮已经通过了审批

It's generic, it's available.

它是通用的，可用的。

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

我们可以在很短的时间用很便宜的价格开发研制

But actually, beyond functional fixedness and mental set,

可是实际上，除了固定思维和教条，

there's a real other challenge to repurposing drugs,

还有另一个挑战

which is policy.

就是制度。

没有奖励制度

There are no incentives in place

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

只要一种药物是通用药物而且没有专利，不再为一家所有

来鼓励药厂研发产品，

to encourage pharma companies to develop them,

because they don't make money.

因为没钱可赚。

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

这不仅仅针对氯胺酮，所有的药都一样。

Regardless, the idea itself is completely novel in psychiatry,

无论怎样，在精神病领域这个

to use drugs to prevent mental illness

使用药物防止精神病

as opposed to just treat it.

而不是相反地去治疗是一个新奇的想法。

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

也许20， 50， 100 年后，

we will look back now at depression and PTSD

我们会回头看抑郁症和创伤后应激障碍症，

the way we look back at tuberculosis sanitoriums

就像我们现在回头看肺结核和疗养院

as a thing of the past.

一样

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

这有可能是结束精神病泛滥的开始。

But as a great scientist once said,

有位伟大的科学家曾说过

"Only a fool is sure of anything.

只要傻子才确知一切。

A wise man keeps on guessing."

聪明人总是不断猜想。

谢谢你们！

Thank you, guys.

(Applause)

（掌声）