What Makes the Drug for Depression So Different?
XXX药治疗抑郁症为咋应答各异? 
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2019-06-12 04:16
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On Tuesday (March 5), the U.S. Food and Drug Administration (FDA) approved a   nasal spray for patients with depression who haven't responded to other treatments.

周二(3月5日),美国食品和药物管理局(FDA)批准对抑郁症患者使用XXX药鼻腔喷雾剂,假若这些抑郁症患者若对其他治疗无效的话。

But what makes this newly approved treatment so different?

但是这个新治疗方法却有不同应答,为咋? 

The drug, called Spravato and made by Janssen Pharmaceuticals, contains the active ingredient esketamine. This substance has the same molecular formula as ketamine but a different chemical structure. (In other words, it contains the same type and number of elements but in a different configuration.) Ketamine is typically used as an anesthetic, but it’s also been used as an illicit party drug.

这种由杨森制药公司(Janssen Pharmaceuticals)生产Spravato的XXX鼻腔喷剂,含有活性艾(esketamine)成分,与(ketamine)分子式相同,化学结构却不一样。换句话说,它有一样的相同数量化学成分,但化学结构不同。通常用作麻醉剂,也用作制造非法药物。

One reason experts are excited about the nasal spray is that its effects can be seen within several hours to days. Other antidepressants, meanwhile, can take weeks to start working. [7 Ways Depression Differs in Men and Women]

医学专家们对XXX鼻腔喷剂感兴趣原因,就是疗效快,几小时或几天就能见奇效。与此相比,一般抗抑郁药则要数周。[ 男性和女性抑郁症的7种差别 ] 

Antidepressants work by regrowing brain cells and the connections between them, and  appears to have the same effects, said David Olson, an assistant professor of chemistry, biochemistry and molecular medicine at the University of California, Davis. But, these effects likely start much sooner than with other antidepressants, he said.

 加州大学戴维斯分校(the University of California, Davis)的化学、生物化学和分子医学助理教授大卫·奥尔森(David Olson)说,抗抑郁药是促使大脑长出新细胞和改善神经细胞相互连接,与功能似乎相同。但是,这种药比一般抗抑郁药见效快。

Still, it's not entirely clear how the drug works.

不过,这种药物药理特性仍没有彻底弄清。 

e-like drugs are "dirty”, meaning they likely hit a variety of targets in the brain, Olson told Live Science. "There are a lot of very interesting hypotheses out there, [and] many of them are probably partially valid."

奥尔森对“生活科学(Live Science)”记者说,XXX类药“药性活跃(dirty)”,能靶向大脑不同目标。“这里有许多非常令人有趣假设,其中主要的就是它的疗效.” 

One idea is that e treats depression by blocking a neurotransmitter called glutamate from binding to the NMDA receptor, and stopping signals from cascading across the brain, Dr. Alan Schatzberg, a professor of psychiatry and behavioral sciences at the Stanford University School of Medicine, told Live Science.

斯坦福大学医学院(Stanford University School of Medicine)精神病学和行为科学教授艾伦·沙茨伯格(Alan Schatzberg)博士告诉“生命科学”记者,治疗抑郁症是通过阻止一种被称为谷氨酸的神经递质与NMDA受体的结合,切断信号通过大脑。 

Glutamate is a chemical that brain cells use to send signals to other brain cells. But high levels of it can cause over-excitement in the brain, which can, in turn, damage brain cells.

它是一种化学物质,脑细胞用它向其他脑细胞发送信号,但是水平过高损伤脑细胞。

A more controversial idea is that e binds to opioid receptors, causing a release of naturally occurring opioids in the body. Schatzberg and his team published a small study on this last summer in which they gave patients with depression ketamine twice — once after receiving an opioid-blocking drug, and once after receiving a placebo in place of the opioid blocker. The two treatments took place about a month apart, and neither the participants nor the researchers knew whether patients received the opioid blocker or the placebo. The study found that the patients responded well to the ketamine treatment if they didn't receive the opioid-blocking drug, bute had no effect on those that did, suggesting an opioid-like role.

日前争议焦点是,XXX药会引起体内阿片类药物自然释放。沙茨伯格Schatzberg和他的科研团队在去年夏天发表的研究报告中说,他们给抑郁症患者服用过两次: 一次是在服用阿片类阻断药后,另一次是用安慰剂代替阿片类阻断药。两次相隔一个月左右。当时,研究人员和受试患者都不知道阿片类阻断药和安慰剂的反应。研究后发现,患者若不适宜阿片类阻断药,XXX类药治疗就有良好应答,与此相反,治疗没有应答患者,阿片类药有效。 

This hypothesis has some experts concerned about -based drugs as a depression treatment.

有一些专家对该类药物用于治疗抑郁症的理论假设甚为关注。 

"My concern about this compound is that it is a disguised form of opiates," said Dr. Mark George, a distinguished professor of psychiatry, radiology and neurosciences at the Medical University of South Carolina. While George said he is "overjoyed" for the prospect of a new treatment option, "I'm alarmed that there is pretty clear evidence [that] the way  works is through the opioid system."

美国南卡罗来纳医科大学(Medical University of South Carolina)精神病学、放射学和神经科学着名教授马克·乔治(Mark George)博士说:“我们注意到XXX类药化学分子是阿片类药变体形式。现在有足够资料证明,它通过阿片类药理系统医治疾病。”乔治对这种治疗新选项前景表示“乐观”。

If this is the mechanism thae acts through to treat depression, its effects won't last and people might develop a tolerance to the drug, possibly even becoming addicted, George told Live Science. But if its antidepressant effects come from other mechanisms, such as blocking the NMDA receptor, then "that's good," he said.

乔治告诉生命科学(Live Science)记者,若是通过阿片类似作用治疗抑郁症,那么药效不会持续,患者对药物会产生抗药性,甚至会上瘾。如果XXX类药抗抑郁机制不是这样,如阻断NMDA受体,乔治说,那就“很好 

Olson, however, said that he is less convinced by the opioid hypothesis and thinks more work needs to be done before ringing the alarm bells.

奥尔森表示不相信这是阿片类药物作用机理假说,不过安全起见,有必要进行更多试验。 

What's more, the new drug will see limited use. The medication comes with a risk of sedation and dissociation, such as difficulty with judgment, attention and thinking. Because of that, the nasal spray was approved to be used only under a "restricted distribution system," according to a statement from the FDA.

更重要的是,新药临床应用受到限制。它具有镇静和分解风险,会出现判断力、注意力和思维能力下降。因此,FDA文件规定,XXX药鼻喷剂只允许在“有限范围条件(restricted distribution system)”下采用。 

This means that only patients with severe depression who haven't responded to at least two antidepressant treatments can receive the drug. In addition, the treatment is administered only in doctor's offices, and patients must stay in the office and be monitored for several hours after receiving the treatment.

 这就是说,接受XXX 鼻喷剂治疗的,只有是重度抑郁症且用过二种以上抗抑郁药治疗无效的患者。而且必须医生办公室内医治,治疗结束后还要留在办公室继续观察数小时。

Ultimately, despite some potential problems with the newly approved drug, experts are hopeful it will come through strong.

然而,FDA新批准的XXX药鼻喷剂虽存在一些潜在问题,专家们仍然希望它能够逐渐完善成熟。

"I think that the FDA approval of is a huge landmark in the history of treating neuropsychiatric diseases," Olson said. "e really represents a leap forward in terms of new ideas for attacking depression and related neuropsychiatric diseases."

奥尔森说:“我认为,FDA批准应用XXX类药治疗重度抑郁症,是神经精神疾病历史上重要里程碑。它代表科研部门为征服抑郁症和相关神经精神疾病开创的新思路,是向前大大跨进了一步。” 

Editor's Note: This story was updated on March 7 to include additional information about Dr. Alan Schatzberg's study.

编辑注:该文已于3月7日根据Alan Schatzberg博士研究补充文献修订。

Originally published on Live Science.

原文发表在Live Science.

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    jiong
    jiong
    4个月前
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    ketamine为***
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    jiong
    jiong
    4个月前
    回复
    因为“ketamine(***)“是敏感词,原文与译文已删除。应在译文---药加上“***”;原文加上ketamine。特此说明。

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