The new emphasis on brain circuits and the newly emerging tools available to study them have electrified neuroscientists and researchers working in the lab. But they haven't yet been translated into new treatments that might relieve anxiety. The last big anti-anxiety medication was Prozac and other selective serotonin reuptake inhibitors, or SSRIs, which came out in the 1980s.
重新重視大腦回路和新工具的出現讓實驗室里的神經科學家和研究人員興奮不已。但它們還沒有被轉化成可能減輕焦慮的新療法。最后一種大型抗焦慮藥物是百憂解(Prozac)和其他選擇性血清素再吸收抑制劑(SSRIs)，于上世紀80年代問世。
"The field has been sort of stagnating for quite a while, actually," says Stefan Hofmann, a professor of psychology and director of the Psychotherapy and Emotion Research Laboratory at Boston University's Center for Anxiety and Related Disorder. "SSRIs came on the market a couple decades ago with big hype. But since then, not much else really happened and I think people are more or less desperate."
“這個領域已經停滯了很長一段時間，”波士頓大學焦慮及相關障礙研究中心心理治療與情緒研究實驗室主任、心理學教授史蒂芬·霍夫曼說。“SSRI類藥物在幾十年前上市時大肆宣傳。但從那以后，就沒發生什么事了，我想人們或多或少有些絕望。”
The awkward truth about current anxiety treatments is that they are for the most part unproven. Although 75 percent of patients who seek help for debilitating anxiety get "substantially better" during the course of treatment, medical scientists don't know to what extent these improvements are due to the treatments themselves or to the placebo effect. Drugs that are effective in tamping down anxiety tend to have many unwanted side-effects. Why 25 percent of patients fail to respond to any treatment at all is another mystery.
關于目前的焦慮癥治療，一個尷尬的事實是，它們大多未經證實。盡管75%因焦慮而尋求幫助的患者在治療過程中“明顯好轉”，但醫學科學家不知道這些改善在多大程度上是由于治療本身或安慰劑效應。能有效緩解焦慮的藥物往往會產生許多副作用。為什么25%的病人對任何治療都毫無反應是另一個謎。
One problem is that mental-health clinicians don't have good ways of diagnosing and classifying mental disorders. For almost 70 years, the diagnostic bible for clinicians treating anxiety and other psychiatric disorders has been the Diagnostic and Statistical Manual of Mental Disorders (DSM), which assigns symptoms to different classifications of various conditions. As brain science has advanced, the DSM has come to be seen by many in the field as an increasingly antiquated and blunt tool that doesn't fully help define what is wrong with a patient.
一個問題是，心理健康醫生沒有診斷和分類精神疾病的好方法。近70年來，《精神疾病診斷與統計手冊》(DSM) 一直是用于臨床醫生治療焦慮和其他精神疾病的診斷圣經，它將癥狀按照不同的情況進行分類。隨著腦科學的進步，DSM已經被該領域的許多人視為一個日益過時和生硬的工具，它并不能完全幫助確定病人的問題所在。
"The problem is, you have a list of some 30, 40 different symptoms for any given disorder, and often you have to only meet four or five of them to get a diagnosis," says BU's Hofmann, who helped revise the latest edition, the DSM-V. "You get an astounding number of possible combinations that all would be described as depression and generalized anxiety disorder. So you have this wide array of people that are assigned to the same diagnostic category. Even though they seem to have similar problems on the surface, they might have very different problems that give rise to these problems."
“問題是，對于任何一種疾病，你都有一個30到40種不同癥狀的列表，通常你只需要滿足其中的4到5種就可以得到診斷，”波士頓大學的霍夫曼說，他幫助修訂了最新版DSM-V。“你會得到數目驚人的可能組合，所有這些組合都可以被描述為抑郁和廣泛性焦慮障礙。所以你有很多人被分配到相同的診斷類別。雖然表面上他們似乎有相似的問題，但他們可能致病原因不同。”
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