TEDxNewYork
Rebecca Brachman: Could a drug prevent depression and PTSD?
Rebecca Brachman: 药物有可能防止抑郁症和创后应激障碍吗？
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发现新药物的路不仅有偶然，也有改革性的发现。在这个科学是如何发生的故事里，神经学家Rebecca Brachman 与我们分享了一项令人兴奋的发现－预防精神疾病，比如抑郁症和创后应激障碍症。听听这个非同一般，具有争议的演讲吧。
Rebecca Brachman - Neuroscientist, writer, entrepreneur
Rebecca Brachman is a pioneer in the field of preventative psychopharmacology, developing drugs to enhance stress resilience and prevent mental illness. Full bio
Rebecca Brachman is a pioneer in the field of preventative psychopharmacology, developing drugs to enhance stress resilience and prevent mental illness. Full bio
Double-click the English transcript below to play the video.
00:13
This is a tuberculosis ward,
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这是一个肺结核病房，
00:16
and at the time this picture was taken
in the late 1800s,
in the late 1800s,
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在十九世纪末
00:19
one in seven of all people
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每七个人中就有一个
00:22
died from tuberculosis.
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死于肺结核。
00:24
We had no idea
what was causing this disease.
what was causing this disease.
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我们不清楚这个病的起因。
00:28
The hypothesis was actually
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我们猜想
00:30
it was your constitution
that made you susceptible.
that made you susceptible.
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可能是我们的体质决定了我们的易感染性。
00:33
And it was a highly romanticized disease.
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而且这种病被披上了浪漫滴外衣。
00:36
It was also called consumption,
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被称为痨病。
00:39
and it was the disorder of poets
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它是诗人，
00:42
and artists and intellectuals.
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艺术家，智者得的病。
00:45
And some people actually thought
it gave you heightened sensitivity
it gave you heightened sensitivity
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有些人甚至认为这种病让你变得更敏感，
00:48
and conferred creative genius.
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并且赋予你天才的特质。
00:52
By the 1950s,
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到二十世纪五十年代，
00:54
we instead knew
that tuberculosis was caused
that tuberculosis was caused
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我们发现肺结核是由
00:57
by a highly contagious
bacterial infection,
bacterial infection,
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一种传染性很强的细菌感染引起的，
01:00
which is slightly less romantic,
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并没有那么浪漫，
01:03
but that had the upside
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然而这
01:05
of us being able to maybe
develop drugs to treat it.
develop drugs to treat it.
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让我们想到研发药物来治疗这种疾病的可能性。
01:08
So doctors had discovered
a new drug, iproniazid,
a new drug, iproniazid,
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于是医生们发现了一种新药－异丙嗪，
01:11
that they were optimistic
might cure tuberculosis,
might cure tuberculosis,
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他们乐观地认为可以治愈肺结核，
01:15
and they gave it to patients,
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他们把这种药给病人服用，
01:16
and patients were elated.
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病人们很兴奋。
01:18
They were more social, more energetic.
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他们变得更活跃，充满生机。
01:22
One medical report actually says
they were "dancing in the halls."
they were "dancing in the halls."
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一项医学报告提到，他们“ 在走廊手舞足蹈。“
01:27
And unfortunately,
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可惜的是
01:29
this was not necessarily
because they were getting better.
because they were getting better.
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这并不意味着他们在康复。
01:32
A lot of them were still dying.
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很多病人依然频临死亡。
01:35
Another medical report describes them
as being "inappropriately happy."
as being "inappropriately happy."
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另外有一份医学报告称他们“不正常得开心”
01:43
And that is how the first
antidepressant was discovered.
antidepressant was discovered.
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第一种抗抑郁药物就这样发明了。
01:47
So accidental discovery
is not uncommon in science,
is not uncommon in science,
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这种巧合在科学领域并不多见，
01:52
but it requires more
than just a happy accident.
than just a happy accident.
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但是它需要的不仅仅是开心的巧合。
01:55
You have to be able to recognize it
for discovery to occur.
for discovery to occur.
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你需要有能力在这种巧合发生的时候抓住它。
01:59
As a neuroscientist,
I'm going to talk to you a little bit
I'm going to talk to you a little bit
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作为一个神经学家，让我与你分享一些
02:02
about my firsthand experience
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我的第一手经验
02:03
with whatever you want to call
the opposite of dumb luck --
the opposite of dumb luck --
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你可能会称之为狗屎运，
02:06
let's call it smart luck.
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我更倾向于称之为聪明的运气。
02:08
But first, a bit more background.
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首先，说说背景知识。
02:12
Thankfully, since the 1950s,
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自二十世纪五十年代，
02:15
we've developed some other drugs
and we can actually now cure tuberculosis.
and we can actually now cure tuberculosis.
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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。
02:19
And at least in the United States,
though not necessarily in other countries,
though not necessarily in other countries,
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至少在美国是这样。
02:22
we have closed our sanitoriums
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我们关闭了疗养院
02:24
and probably most of you
are not too worried about TB.
are not too worried about TB.
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而且可能你们大部分人已经不是那么担心肺结核。
02:28
But a lot of what was true
in the early 1900s
in the early 1900s
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可是在二十世纪初我们对于
02:31
about infectious disease,
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传染病的担心，
02:33
we can say now
about psychiatric disorders.
about psychiatric disorders.
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和当今的精神病类似。
02:36
We are in the middle
of an epidemic of mood disorders
of an epidemic of mood disorders
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我们正陷于情绪困扰之中
02:39
like depression and post-traumatic
stress disorder, or PTSD.
stress disorder, or PTSD.
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比如抑郁症和创后应激障碍，PTSD。
02:44
One in four of all adults
in the United States
in the United States
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在美国，每四个人中就有一个
02:48
suffers from mental illness,
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受精神疾病的困扰，
02:50
which means that if you haven't
experienced it personally
experienced it personally
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也就是说即使你可能本身没有，
02:53
or someone in your family hasn't,
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或者你的家人没有，
02:55
it's still very likely
that someone you know has,
that someone you know has,
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可是很有可能你认识的人有，
02:58
though they may not talk about it.
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只是他们不说而已。
03:02
Depression has actually now surpassed
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抑郁症实际上已经超越了
03:05
HIV/AIDS, malaria, diabetes and war
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艾滋病，疟疾，糖尿病和战争
03:10
as the leading cause
of disability worldwide.
of disability worldwide.
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成为全球范围健康的头号杀手。
03:13
And also, like tuberculosis in the 1950s,
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就像二十世纪五十年代时的肺结核一样，
03:17
we don't know what causes it.
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我们不清楚它的起因。
03:19
Once it's developed, it's chronic,
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一旦发病，就是慢性
03:21
lasts a lifetime,
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会伴随你一生，
03:22
and there are no known cures.
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而且目前无法治愈。
03:26
The second antidepressant we discovered,
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第二种抗抑郁药同样
03:28
also by accident, in the 1950s,
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偶然发现于二十世纪五十年代，
03:31
from an antihistamine
that was making people manic,
that was making people manic,
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是从让人躁狂的抗组胺药中发现的，
03:35
imipramine.
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丙咪嗪。
03:38
And in both the case of the tuberculosis
ward and the antihistamine,
ward and the antihistamine,
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无论是在结核病还是抗组胺药的个案中，
03:41
someone had to be able to recognize
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都需要有人发现
03:43
that a drug that was designed
to do one thing --
to do one thing --
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一种本来用于治疗一种病的药物
03:46
treat tuberculosis
or suppress allergies --
or suppress allergies --
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治疗结核或者抗过敏
03:48
could be used to do
something very different --
something very different --
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都可以用于完全不同的治疗－
03:51
treat depression.
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治疗抑郁症。
03:53
And this sort of repurposing
is actually quite challenging.
is actually quite challenging.
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这种改变事实上非常具有挑战性。
03:56
When doctors first saw
this mood-enhancing effect of iproniazid,
this mood-enhancing effect of iproniazid,
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当医生们最早看到异丙嗪情绪提升的作用时，
04:00
they didn't really recognize
what they saw.
what they saw.
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他们并没有意识到他们看到的是什么。
04:02
They were so used to thinking about it
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他们总是习惯性地从
04:04
from the framework
of being a tuberculosis drug
of being a tuberculosis drug
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治疗肺结核的药物
04:07
that they actually just listed it
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的副作用
04:09
as a side effect, an adverse side effect.
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不良的副作用来考虑。
04:12
As you can see here,
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基于这个原因，
04:13
a lot of these patients in 1954
are experiencing severe euphoria.
are experiencing severe euphoria.
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在1954 年许多病人表现出异常的快乐。
04:18
And they were worried
that this might somehow interfere
that this might somehow interfere
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于是医生们担心这种状态会影响病人
04:22
with their recovering from tuberculosis.
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肺结核的治疗。
04:25
So they recommended that iproniazid
only be used in cases of extreme TB
only be used in cases of extreme TB
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于是他们建议异丙嗪只可以用于严重的结核病患者
04:31
and in patients that were
highly emotionally stable,
highly emotionally stable,
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以及心理状态非常稳定的病人，
04:36
which is of course the exact opposite
of how we use it as an antidepressant.
of how we use it as an antidepressant.
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这显然和我们治疗抑郁病患者截然相反。
04:40
They were so used to looking at it
from the perspective of this one disease,
from the perspective of this one disease,
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他们太过习惯于只关注一个病的状况，
04:44
they could not see the larger implications
for another disease.
for another disease.
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而未能从另一个疾病的角度看到药物更广的适用。
04:49
And to be fair,
it's not entirely their fault.
it's not entirely their fault.
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公正地说，这不全是他们的错。
04:52
Functional fixedness
is a bias that affects all of us.
is a bias that affects all of us.
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我们可能都受着教条主义的影响，
04:54
It's a tendency to only
be able to think of an object
be able to think of an object
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我们倾向于只考虑一个事物
04:58
in terms of its traditional
use or function.
use or function.
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传统意义上的使用和功能。
05:01
And mental set is another thing. Right?
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而且思维方式是另一回事。 对吗？
05:03
That's sort of this preconceived framework
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这种
05:05
with which we approach problems.
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我们用于思考的思维定式
05:07
And that actually makes repurposing
pretty hard for all of us,
pretty hard for all of us,
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使得发散思考变得相当困难，
05:10
which is, I guess, why they gave
a TV show to the guy who was,
a TV show to the guy who was,
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也就是，我想，为什么电视节目亲赖于那些
05:14
like, really great at repurposing.
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善于发散性思维的人们。
05:16
(Laughter)
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（笑声）
05:19
So the effects in both the case
of iproniazid and imipramine,
of iproniazid and imipramine,
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所以，在这两个例子中，异丙嗪和丙咪嗪
05:23
they were so strong --
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药效都很强－
05:24
there was mania,
or people dancing in the halls.
or people dancing in the halls.
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狂躁或是人们在走廊跳舞。
05:27
It's actually not that surprising
they were caught.
they were caught.
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他们被注意到并不奇怪。
05:30
But it does make you wonder
what else we've missed.
what else we've missed.
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那么你会否想到我们是否还忽视了其他东西。
05:35
So iproniazid and imipramine,
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所以异丙嗪和丙咪嗪
05:37
they're more than just
a case study in repurposing.
a case study in repurposing.
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他们不仅仅是发散思维的一个案例，
05:39
They have two other things in common
that are really important.
that are really important.
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他们有其他两样重要的共性，
05:42
One, they have terrible side effects.
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其一， 他们有很强的副作用
05:45
That includes liver toxicity,
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包括肝中毒，
05:47
weight gain of over 50 pounds,
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体重增加超过50 磅，
05:50
suicidality.
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自杀倾向。
05:52
And two, they both
increase levels of serotonin,
increase levels of serotonin,
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第二， 他们都增加了血清素的指标
05:56
which is a chemical signal in the brain,
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大脑中的一个化学信号，
05:59
or a neurotransmitter.
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或者神经传递组织。
06:01
And those two things together,
right, one or the two,
right, one or the two,
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这两个副作用一起，对，第一个或者第二个
06:03
may not have been that important,
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可能不是那么重要，
06:05
but the two together meant
that we had to develop safer drugs,
that we had to develop safer drugs,
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但是两者合并意味着我们必须开发更安全的药物
06:09
and that serotonin seemed
like a pretty good place to start.
like a pretty good place to start.
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而且血清素似乎是个好的突破口。
06:13
So we developed drugs
to more specifically focus on serotonin,
to more specifically focus on serotonin,
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于是我们研制了专注于血清素的药物，
06:17
the selective serotonin
reuptake inhibitors, so the SSRIs,
reuptake inhibitors, so the SSRIs,
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选择性5-羟色胺再摄取抑制剂， SSRIs，
06:21
the most famous of which is Prozac.
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最有名的就是Prozac。
06:24
And that was 30 years ago,
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那是30 年前，
06:26
and since then we have mostly
just worked on optimizing those drugs.
just worked on optimizing those drugs.
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从那时起我们致力于优化这些药物。
06:29
And the SSRIs, they are better
than the drugs that came before them,
than the drugs that came before them,
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SSRI类药物比以前的药物都好，
06:32
but they still have a lot of side effects,
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但是他们也还有副作用，
06:35
including weight gain, insomnia,
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包括体重增加，失眠，
06:38
suicidality --
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自杀倾向－
06:40
and they take a really long time to work,
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而且药效产生慢，
06:42
something like four to six weeks
in a lot of patients.
in a lot of patients.
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有些患者需要4到6个星期才见效。
06:45
And that's in the patients
where they do work.
where they do work.
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这是在那些药物产生疗效的患者中。
06:47
There are a lot of patients
where these drugs don't work.
where these drugs don't work.
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也有许多患者对药物没有反应。
06:50
And that means now, in 2016,
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也就是说，现在，在2016年，
06:53
we still have no cures
for any mood disorders,
for any mood disorders,
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我们依然没有治愈情绪障碍的药物，
06:57
just drugs that suppress symptoms,
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只有抑制症状的药物，
06:59
which is kind of the difference between
taking a painkiller for an infection
taking a painkiller for an infection
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就好像治疗感染的时候，止痛药和
07:03
versus an antibiotic.
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抗菌素的区别。
07:04
A painkiller will make you feel better,
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止痛药让你感觉好些，
07:06
but is not going to do anything
to treat that underlying disease.
to treat that underlying disease.
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但不能治愈引起痛症的病。
07:10
And it was this flexibility
in our thinking
in our thinking
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是我们思维的灵活性
07:13
that let us recognize
that iproniazid and imipramine
that iproniazid and imipramine
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让我们发现 了异丙嗪和丙咪嗪
07:16
could be repurposed in this way,
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可以用作其他用途，
07:18
which led us to the serotonin hypothesis,
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引领我们走向血清素，
07:20
which we then, ironically, fixated on.
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然后我们专注于
07:23
This is brain signaling, serotonin,
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大脑的信号，血清素
07:26
from an SSRI commercial.
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一种SSRI药物
07:27
In case you're not clear,
this is a dramatization.
this is a dramatization.
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如果你不清楚的话，这是图示。
07:30
And in science, we try
and remove our bias, right,
and remove our bias, right,
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在科学领域，我们尽可能排除偏见，是吧？
07:34
by running double-blinded experiments
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通过双盲试验
07:37
or being statistically agnostic
as to what our results will be.
as to what our results will be.
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或者对我们的试验数据持中立的态度。
07:40
But bias creeps in more insidiously
in what we choose to study
in what we choose to study
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但是偏见却悄悄地渗入到我们研究的课题
07:45
and how we choose to study it.
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以及我们选择的研究方法。
07:48
So we've focused on serotonin now
for the past 30 years,
for the past 30 years,
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所以在过去30年我们潜心于血清素的同时，
07:51
often to the exclusion of other things.
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也排除了其他的事物。
07:54
We still have no cures,
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我们依然没有根治的方法。
07:57
and what if serotonin
isn't all there is to depression?
isn't all there is to depression?
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假如血清素不是抑郁的全部？
08:00
What if it's not even the key part of it?
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或者如果它根本不是抑郁的核心？
08:02
That means no matter how much time
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那就意味着无论我们花多少时间
08:04
or money or effort we put into it,
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或是金钱，或是努力，
08:07
it will never lead to a cure.
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我们永远找不到治愈的办法。
08:10
In the past few years,
doctors have discovered
doctors have discovered
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在过去的几年，医生们发现了
08:13
probably what is the first truly new
antidepressant since the SSRIs,
antidepressant since the SSRIs,
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自从SSRI以来的第一种新抗抑郁药
08:18
Calypsol,
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Calypsol
08:19
and this drug works very quickly,
within a few hours or a day,
within a few hours or a day,
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而且这种药见效快，只需几个小时或者一天。
08:23
and it doesn't work on serotonin.
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而且它不影响血清素。
08:25
It works on glutamate,
which is another neurotransmitter.
which is another neurotransmitter.
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它作用于谷氨酸，另一种神经传感器。
08:28
And it's also repurposed.
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这也是一个重新定位的例子。
08:29
It was traditionally used
as anesthesia in surgery.
as anesthesia in surgery.
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这种药传统上是用于手术中的麻醉剂。
08:33
But unlike those other drugs,
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不像其他的药物，
08:35
which were recognized pretty quickly,
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很快就得到认同，
08:37
it took us 20 years
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人们用了20 年
08:38
to realize that Calypsol
was an antidepressant,
was an antidepressant,
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才意识到 Calypsol 是一种抗抑郁药物。
08:41
despite the fact that it's actually
a better antidepressant,
a better antidepressant,
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尽管事实上
08:44
probably, than those other drugs.
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它可能比其他的药物都更有效。
08:45
It's actually probably because of the fact
that it's a better antidepressant
that it's a better antidepressant
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事实上有可能正因为它是一种更有效的抗抑郁药
08:50
that it was harder for us to recognize.
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所以才更难以被大家认识。
08:52
There was no mania to signal its effects.
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没有狂躁来凸显它的副作用。
08:54
So in 2013, up at Columbia University,
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所以在2013年， 在哥伦比亚大学，
08:57
I was working with my colleague,
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我在和我的同事
08:59
Dr. Christine Ann Denny,
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Christine Ann Denny 博士工作
09:01
and we were studying Calypsol
as an antidepressant in mice.
as an antidepressant in mice.
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我们在研究Calypsol作为抗抑郁药物在老鼠身上的反应。
09:05
And Calypsol has, like,
a really short half-life,
a really short half-life,
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Calypsol的半衰期很短，
09:08
which means it's out of your body
within a few hours.
within a few hours.
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就是说它在几小时内就会被排出体外。
09:11
And we were just piloting.
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我们只是在试验，
09:13
So we would give an injection to mice,
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所以我们会给老鼠注射
09:15
and then we'd wait a week,
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我们然后等一个星期，
09:16
and then we'd run
another experiment to save money.
another experiment to save money.
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然后我们为了省钱会再进行另一个试验。
09:20
And one of the experiments I was running,
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在我的一个试验中，
09:22
we would stress the mice,
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我们会给老鼠们施加压力，
09:23
and we used that as a model of depression.
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我们把这当作一个抑郁样本。
09:26
And at first it kind of just looked
like it didn't really work at all.
like it didn't really work at all.
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起初看起来好像根本没什么作用
09:29
So we could have stopped there.
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所以我们本应该停止。
09:31
But I have run this model
of depression for years,
of depression for years,
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但是我做这个抑郁试验多年，
09:34
and the data just looked kind of weird.
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收集到的数据有些怪。
09:36
It didn't really look right to me.
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反正就是看起来不对。
09:38
So I went back,
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于是我回去，
09:39
and we reanalyzed it
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重新分析
09:41
based on whether or not they had gotten
that one injection of Calypsol
that one injection of Calypsol
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根据它们是否被注射 Calypsol
09:44
a week beforehand.
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一星期前
09:46
And it looked kind of like this.
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数据是这样的
09:48
So if you look at the far left,
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如果你看最左边，
09:51
if you put a mouse in a new space,
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如果你把一只老鼠放在一个新环境
09:53
this is the box, it's very exciting,
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这是那个盒子，它很兴奋，
09:55
a mouse will walk around and explore,
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老鼠会到处走来走去。
09:58
and you can see that pink line
is actually the measure of them walking.
is actually the measure of them walking.
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你看到的粉色线时它们走动的记录
10:02
And we also give it
another mouse in a pencil cup
another mouse in a pencil cup
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我们还给它提供了另外一只装在笔盒里的老鼠
10:05
that it can decide to interact with.
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如果它愿意，可以和它交流。
10:07
This is also a dramatization,
in case that's not clear.
in case that's not clear.
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这也是一个图示，让大家看得更清楚。
10:10
And a normal mouse will explore.
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一个正常的老鼠会探索。
10:14
It will be social.
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会社交。
10:16
Check out what's going on.
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查看周围在发生什么。
10:18
If you stress a mouse
in this depression model,
in this depression model,
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如果你给老鼠压力，让它抑郁，
10:20
which is the middle box,
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像中间的这个盒子，
10:23
they aren't social, they don't explore.
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它们不会社交，不会探索，
10:25
They mostly just kind of hide
in that back corner, behind a cup.
in that back corner, behind a cup.
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多数时间它们会躲在杯子后面角落。
10:29
Yet the mice that had gotten
that one injection of Calypsol,
that one injection of Calypsol,
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然而那些注射了一针Calypsol的老鼠
10:32
here on your right,
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在右边
10:34
they were exploring, they were social.
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它们在探索，在交流。
10:36
They looked like they
had never been stressed at all,
had never been stressed at all,
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它们看上去似乎从未被抑郁
10:40
which is impossible.
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不可思议。
10:42
So we could have just stopped there,
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我们本可以就此打住，
10:44
but Christine had also used
Calypsol before as anesthesia,
Calypsol before as anesthesia,
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但是Christine曾经使用过Calypsol 做为麻醉药物，
10:49
and a few years ago she had seen
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几年前她曾经看到
10:50
that it seemed to have
some weird effects on cells
some weird effects on cells
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它似乎对细胞有些奇怪的作用
10:53
and some other behavior
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而且一些其他行为
10:54
that also seemed to last
long after the drug,
long after the drug,
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似乎在用药之后持续很久，
10:57
maybe a few weeks.
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可能有几个星期。
10:58
So we were like, OK,
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于是我们觉得，好的，
10:59
maybe this is not completely impossible,
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也许这不是完全不可能。
11:02
but we were really skeptical.
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但是我们也充满疑惑。
11:03
So we did what you do in science
when you're not sure,
when you're not sure,
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于是我们做了在科学上当你疑惑的时候该做的事，
11:06
and we ran it again.
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再次试验。
11:08
And I remember being in the animal room,
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我记得在动物房
11:11
moving mice from box to box
to test them,
to test them,
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把老鼠从一个盒子放到另一个盒子来试验它们，
11:15
and Christine was actually sitting
on the floor with the computer in her lap
on the floor with the computer in her lap
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Christine 就坐在地上， 腿上放着她的手提电脑，
11:18
so the mice couldn't see her,
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这样老鼠就看不到她。
11:20
and she was analyzing
the data in real time.
the data in real time.
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她在做实地数据分析。
11:22
And I remember us yelling,
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我记得我们大叫，
11:23
which you're not supposed to do
in an animal room where you're testing,
in an animal room where you're testing,
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（当然不应该在做测试的动物房这样做）
11:27
because it had worked.
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因为我们成功了。
11:28
It seemed like these mice
were protected against stress,
were protected against stress,
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似乎这些老鼠受到了能够对抗压力的保护，
11:33
or they were inappropriately happy,
however you want to call it.
however you want to call it.
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或者说他们不适当地快乐，你怎么形容都好。
11:36
And we were really excited.
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我们非常激动。
11:39
And then we were really skeptical,
because it was too good to be true.
because it was too good to be true.
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然后我们变得很疑惑因为这个结果好得令人难以置信。
11:43
So we ran it again.
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1200
于是我们又做了一次试验。
11:45
And then we ran it again in a PTSD model,
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我们又做了一次，不过是用 PTSD 模式
11:48
and we ran it again
in a physiological model,
in a physiological model,
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然后我们又做了一次心理试验模式
11:50
where all we did was give stress hormones.
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我们给他们压力荷尔蒙
11:53
And we had our undergrads run it.
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我们让本科生做的实验
11:54
And then we had our collaborators
halfway across the world in France run it.
halfway across the world in France run it.
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然后我们让在法国的合作者实验
11:59
And every time someone ran it,
they confirmed the same thing.
they confirmed the same thing.
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每一次的试验都验证了同样的结果。
12:03
It seemed like
this one injection of Calypsol
this one injection of Calypsol
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似乎一剂 Calypsol 的注射
12:05
was somehow protecting
against stress for weeks.
against stress for weeks.
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可以防止压力过量几个星期。
12:09
And we only published this a year ago,
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一年前我们发表了这个，
12:11
but since then other labs
have independently confirmed this effect.
have independently confirmed this effect.
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从那时起其他的实验室独立验证了这项效果
12:15
So we don't know what causes depression,
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所以我们不知道抑郁的本源，
12:18
but we do know that stress
is the initial trigger
is the initial trigger
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但是我们知道压力是诱因
12:22
in 80 percent of cases,
256
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百分之八十的个案中，
12:24
and depression and PTSD
are different diseases,
are different diseases,
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抑郁和创伤后应激障碍是不同的疾病，
12:26
but this is something
they share in common.
they share in common.
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2016
但是他们有共性
12:28
Right? It is traumatic stress
259
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对吧？那就是强大的压力
12:30
like active combat or natural disasters
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就像剧烈的战斗或者自然灾害
12:33
or community violence or sexual assault
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或者社区暴力，性侵
12:36
that causes post-traumatic
stress disorder,
stress disorder,
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都会引起创伤后应激障碍，
12:38
and not everyone that is exposed to stress
develops a mood disorder.
develops a mood disorder.
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5616
但是不是每个经历过刺激的人都会产生情绪障碍。
12:44
And this ability to experience
stress and be resilient
stress and be resilient
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这种经历创伤但能恢复
12:47
and bounce back and not develop
depression or PTSD
depression or PTSD
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而且不形成抑郁或创伤后应激障碍
12:52
is known as stress resilience,
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就是我们说的抗压恢复能力。
12:54
and it varies between people.
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这种能力每个人都不一样。
12:56
And we have always thought of it
as just sort of this passive property.
as just sort of this passive property.
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3336
我们一直以为它是一种负面因素
13:00
It's the absence of susceptibility factors
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是缺乏敏感因素
13:02
and risk factors for these disorders.
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以及这些心理障碍的风险因素
13:05
But what if it were active?
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但是如果它是活性的，
13:08
Maybe we could enhance it,
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也许我们可以加强它
13:09
sort of akin to putting on armor.
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好像给它戴上盔甲。
13:13
We had accidentally discovered
the first resilience-enhancing drug.
the first resilience-enhancing drug.
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我们碰巧发现了第一种提高抗压力的药物。
13:18
And like I said, we only gave
a tiny amount of the drug,
a tiny amount of the drug,
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像我说的那样，我们只给了很小剂量的药物，
13:21
and it lasted for weeks,
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药效持续了几个星期，
13:23
and that's not like anything
you see with antidepressants.
you see with antidepressants.
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3216
这不是你所了解的抗抑郁药物。
13:26
But it is actually kind of similar
to what you see in immune vaccines.
to what you see in immune vaccines.
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4320
但是它却像是接种疫苗
13:31
So in immune vaccines,
you'll get your shots,
you'll get your shots,
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2936
如果你接种了疫苗，
13:34
and then weeks, months, years later,
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3376
那么几周，几个月，几年后，
13:37
when you're actually exposed to bacteria,
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当你接触细菌的时候
13:39
it's not the vaccine in your body
that protects you.
that protects you.
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不是你身体里的疫苗在保护你，
13:42
It's your own immune system
283
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1376
是你自身的免疫系统
13:43
that's developed resistance and resilience
to this bacteria that fights it off,
to this bacteria that fights it off,
284
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4136
已经产生了对这种细菌的抗体在对抗细菌
13:47
and you actually never get the infection,
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2136
而你从未真正被感染过。
13:50
which is very different
from, say, our treatments. Right?
from, say, our treatments. Right?
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这和我们的治疗不同，是吧？
13:53
In that case, you get the infection,
you're exposed to the bacteria,
you're exposed to the bacteria,
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3816
在那种情况下，你接种，接触细菌，
13:57
you're sick, and then you take,
say, an antibiotic which cures it,
say, an antibiotic which cures it,
288
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你生病，然后你吃抗生素来治疗
14:00
and those drugs are actually working
to kill the bacteria.
to kill the bacteria.
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3240
而那些药物实际上杀死了细菌
14:04
Or similar to as I said before,
with this palliative,
with this palliative,
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2496
或者像我以前所说的，使用这种姑息治疗，
14:07
you'll take something
that will suppress the symptoms,
that will suppress the symptoms,
291
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2856
你服用药物掩盖病症，
14:10
but it won't treat
the underlying infection,
the underlying infection,
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2696
而不能治愈引起病痛的源头
14:12
and you'll only feel better
during the time in which you're taking it,
during the time in which you're taking it,
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3336
在你用药的时候你觉得好些，
14:16
which is why you have to keep taking it.
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于是你不得不持续用药。
14:18
And in depression and PTSD --
295
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对于抑郁和创伤后应激障碍
14:20
here we have your stress exposure --
296
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1976
我们看到你的焦虑
14:22
we only have palliative care.
297
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2616
我们只能保守治疗，
14:25
Antidepressants only suppress symptoms,
298
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抗抑郁药只能缓解症状，
14:28
and that is why you basically
have to keep taking them
have to keep taking them
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所以你得不停地使用药物
14:30
for the life of the disease,
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在你整个患病阶段
14:32
which is often
the length of your own life.
the length of your own life.
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通常会是你的一生。
14:35
So we're calling our resilience-enhancing
drugs "paravaccines,"
drugs "paravaccines,"
302
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4216
所以我们把提升恢复能力的药叫做类疫苗
14:40
which means vaccine-like,
303
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意思是和疫苗相似
14:41
because it seems
like they might have the potential
like they might have the potential
304
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因为它似乎有
14:44
to protect against stress
305
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1816
抗焦虑的潜质
14:46
and prevent mice from developing
306
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防止老鼠患上
14:49
depression and post-traumatic
stress disorder.
stress disorder.
307
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2760
抑郁症和创伤后应激障碍症。
14:52
Also, not all antidepressants
are also paravaccines.
are also paravaccines.
308
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3440
而且，不是所有的抗抑郁药物都是疫苗类的。
14:57
We tried Prozac as well,
309
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我们尝试过Prozac，
14:58
and that had no effect.
310
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没有效果。
15:01
So if this were to translate into humans,
311
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所以如果用于人类的话，
15:04
we might be able to protect people
312
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我们可能可以保护那些
15:06
who are predictably at risk
313
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高危人群
15:08
against stress-induced disorders
like depression and PTSD.
like depression and PTSD.
314
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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。
比如抑郁症和创伤后应激障碍症。
15:12
So that's first responders
and firefighters,
and firefighters,
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也就是第一反应者，消防员，
15:16
refugees, prisoners and prison guards,
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难民，罪犯，监管人员
15:20
soldiers, you name it.
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士兵，等等。
15:23
And to give you a sense
of the scale of these diseases,
of the scale of these diseases,
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让我们了解一下这些疾病的数据
15:27
in 2010, the global burden of disease
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在2010年，全球疾病负担
15:30
was estimated at 2.5 trillion dollars,
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大约2.5万亿
15:35
and since they are chronic,
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由于它们是慢性病
15:36
that cost is compounding
and is therefore expected to rise
and is therefore expected to rise
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这个花销还要复加，所以预期会
15:39
up to six trillion dollars
in just the next 15 years.
in just the next 15 years.
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在未来15 年内上升到6万亿元。
15:44
As I mentioned before,
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我前面提到过
15:46
repurposing can be challenging
because of our prior biases.
because of our prior biases.
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基于我们的偏见，发散思维具有挑战性
15:50
Calypsol has another name,
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Calypsol 有另一个名字
15:53
ketamine,
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氯胺酮
15:55
which also goes by another name,
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也称作
15:57
Special K,
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K 仔
15:58
which is a club drug and drug of abuse.
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是一种在夜总会可以见到的被滥用的药物。
16:02
It's still used across the world
as an anesthetic.
as an anesthetic.
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它还在全世界被用作麻醉剂。
16:05
It's used in children.
We use it on the battlefield.
We use it on the battlefield.
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它被用于儿童。我们在战场使用。
16:08
It's actually the drug of choice
in a lot of developing nations,
in a lot of developing nations,
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在很多国家属于非处方药物
16:11
because it doesn't affect breathing.
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因为它不会影响呼吸。
16:13
It is on the World Health Organization
list of most essential medicines.
list of most essential medicines.
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在世界卫生组织被列为必要药物。
16:18
If we had discovered ketamine
as a paravaccine first,
as a paravaccine first,
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如果我们早些发现氯胺酮可以用作疫苗
16:22
it'd be pretty easy for us to develop it,
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那我们就可以把他研发成疫苗
16:25
but as is, we have to compete
with our functional fixedness
with our functional fixedness
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可是，我们不得不对抗我们的功能固定性
16:29
and mental set that kind of interfere.
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以及教条思维
16:33
Fortunately, it's not
the only compound we have discovered
the only compound we have discovered
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幸运的是，这不是我们发现的唯一
16:37
that has these prophylactic,
paravaccine qualities,
paravaccine qualities,
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具有疫苗潜质的药物。
16:41
but all of the other drugs
we've discovered,
we've discovered,
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但是所有其他我们发现的药物
16:44
or compounds if you will,
they're totally new,
they're totally new,
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都很新
16:46
they have to go through
the entire FDA approval process --
the entire FDA approval process --
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它们不得不通过整个药物与食品审批过程
16:50
if they make it before
they can ever be used in humans.
they can ever be used in humans.
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在他们可以在人身上使用之前
16:54
And that will be years.
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我们得等许多年。
16:55
So if we wanted something sooner,
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所以如果我们早些
16:58
ketamine is already FDA-approved.
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氯胺酮已经通过了审批
17:00
It's generic, it's available.
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它是通用的，可用的。
17:03
We could develop it for a fraction
of the price and a fraction of the time.
of the price and a fraction of the time.
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我们可以在很短的时间用很便宜的价格开发研制
17:08
But actually, beyond
functional fixedness and mental set,
functional fixedness and mental set,
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可是实际上，除了固定思维和教条，
17:12
there's a real other challenge
to repurposing drugs,
to repurposing drugs,
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还有另一个挑战
17:16
which is policy.
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就是制度。
17:18
There are no incentives in place
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没有奖励制度
17:20
once a drug is generic and off patent
and no longer exclusive
and no longer exclusive
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只要一种药物是通用药物而且没有专利，不再为一家所有
17:24
to encourage pharma companies
to develop them,
to develop them,
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来鼓励药厂研发产品，
17:26
because they don't make money.
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因为没钱可赚。
17:28
And that's not true for just ketamine.
That is true for all drugs.
That is true for all drugs.
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这不仅仅针对氯胺酮，所有的药都一样。
17:32
Regardless, the idea itself
is completely novel in psychiatry,
is completely novel in psychiatry,
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无论怎样，在精神病领域这个
17:38
to use drugs to prevent mental illness
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使用药物防止精神病
17:42
as opposed to just treat it.
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而不是相反地去治疗是一个新奇的想法。
17:44
It is possible that 20, 50,
100 years from now,
100 years from now,
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也许20， 50， 100 年后，
17:49
we will look back now
at depression and PTSD
at depression and PTSD
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我们会回头看抑郁症和创伤后应激障碍症，
17:53
the way we look back
at tuberculosis sanitoriums
at tuberculosis sanitoriums
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就像我们现在回头看肺结核和疗养院
17:57
as a thing of the past.
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一样
17:59
This could be the beginning of the end
of the mental health epidemic.
of the mental health epidemic.
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这有可能是结束精神病泛滥的开始。
18:05
But as a great scientist once said,
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有位伟大的科学家曾说过
18:09
"Only a fool is sure of anything.
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只要傻子才确知一切。
18:12
A wise man keeps on guessing."
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聪明人总是不断猜想。
18:16
Thank you, guys.
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谢谢你们！
18:17
(Applause)
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（掌声）
ABOUT THE SPEAKER
Rebecca Brachman - Neuroscientist, writer, entrepreneurRebecca Brachman is a pioneer in the field of preventative psychopharmacology, developing drugs to enhance stress resilience and prevent mental illness.
Why you should listen
Current treatments for mood disorders only suppress symptoms without addressing the underlying disease, and there are no known cures. The drugs Rebecca Brachman is developing would be the first to prevent psychiatric disorders such as post-traumatic stress disorder (PTSD) and depression.
Brachman completed her PhD at Columbia University, prior to which she was a fellow at the National Institutes of Health, where she discovered that immune cells carry a memory of psychological stress and that white blood cells can act as antidepressants and resilience-enhancers. Brachman's research has been featured in The Atlantic, WIRED and Business Insider, and her work was recently described by Dr. George Slavich on NPR as a "moonshot project that is very much needed in the mental health arena."
In addition to conducting ongoing research at Columbia, Brachman is an NYCEDC Entrepreneurship Lab Fellow and cofounder of Paravax -- a biotech startup developing vaccine-like prophylactic drugs ("paravaccines") -- along with her scientific collaborator, Christine Ann Denny. She is also working on a non-profit venture to repurpose existing generic drugs for use as prophylactics, and previously served as the Interim Program Director for Outreach at the Zuckerman Institute at Columbia University.
Brachman is also a playwright and screenwriter. She holds Bachelor's degrees in both neuroscience and creative wWriting, and she is currently working on a tech-focused writing project with her long-time writing partner, Sean Calder ("Grimm," "Damages," "ER"). She served as the director of NeuWrite, a national network of science-writing groups that fosters ongoing collaboration between scientists, writers and artists, and she has been featured as a storyteller at The Story Collider.
(Photo: Kenneth Willardt)
Rebecca Brachman | Speaker | TED.com