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你心情不不好時﹐面部表情最像其中的那一位呢 ? 五個怪男頭 “Five Grotesque Male Heads” 達文西的鋼筆與褐墨水畫, 26公分 x 20.5公分﹐1490年畫作﹐現為英國溫莎城堡內皇家收藏品。

你為何憂鬱 ?

藉由複雜的神經纖維連結的神經系統, 我們才能夠因應外界的環境變化而產生適當的身體反應, 並且有思考、記憶、情緒變化的能力。以生物化學的角度來說﹐人體大腦中神經傳導物資 (Neurotransmitter) 的不平衡是解釋導致憂鬱症的主要原因。大腦中的神經傳導物質如Dopamine, Serotonin, Norepinephrine 均會影響情緒；例如當腦部釋放Serotonin可使壓力獲得舒解；當腦部釋放Dopamine或Norepinephrine可使我們的思路和行動更敏捷。其中負責信息傳導的血清素 5-HT (Serotonin) 最重要﹐血清素於中樞神經系統之突觸間隙 (Synaptic Junction)濃度多少左右人的情緒穩定。新一代的暢銷抗憂鬱藥如綠白膠囊包裝的百解憂Prozac ﹐都是阻擋從傳導神經末梢釋放出來的血清素被再吸收﹐提昇血清素於中樞神經系統中濃度。另一種抗憂鬱藥則是抑阻氧化血清素的酵素MAO- Monoamine Oxidase的機能, 防止血清素被氧化代謝掉。

2001年12月19日的《美國醫學會雜誌 JAMA》的一篇研究報導，三種最常用於治療憂鬱症的選擇性血清素再吸收抑制劑SSRI –Selective Serotonin Re-Uptake Inhibitor ﹐具有程度相同的治療效果。這研究的進行重點是關於各種SSRI的臨床療效比較的研究。印第安那州波利斯印第安那大學醫學院藥學教授Kurt Kroenke說儘管醫生通常認為同一種類的藥物有類似的臨床效果﹐比較結果對此論點加以驗證。

此次為期9個月的研究中，對573位經他們的基層醫療醫師診斷患有憂鬱症而需要進行憂鬱治療的患者，進行三種美國現今最常用的抗憂鬱藥Paxil﹐Prozac ﹐ Zoloft 混合治療。這三種藥物的活性成份分別是paroxetine (藥品名稱Paxil由Glaxo-Smithkline藥廠生產), fluoxetine (藥品名稱Prozac 由Eli Lilly藥廠生產), 及 sertraline (藥品名稱Zoloft 由Pfizer藥廠生產)。他們針對藥物在包括社會交際、工作能力、性功能與睡眠等健康相關生活品質指標，抗抑鬱效果以及副作用方面評估。結果發現Paxil﹐Prozac ﹐ Zoloft的治療效果是類似的。

儘管此次研究的三種SSRI，可能都有它們自己的一些特點﹐而也因病人基因遺傳上的不同﹐使其對某一個特定的病人應用效果不一樣。可是研究結果顯示這三種藥物，在治療效果方面，沒有任何一種，優於其他兩種藥物。其實最重要的是想辦法改變環境因素﹐不要鑽牛角尖想太多﹐跟信任的親友多談話﹐常使自己心情保持愉快。

原研究刊於 “Similar Effectiveness of Paroxetine, Fluoxetine, and Sertraline in Primary Care : A Randomised Trial”
K. Kroenke et al Journal of American Medical Association (2001) Volume 286 p2947.

本文主角血清素- SEROTONIN化學名稱 5-HT - 5 Hydroxytrypamine由前驅物5 Hydroxytryptophan(5-HTP) 經酵素Tryptophan Hydroxylase轉化而成。單胺氧化脢Monoamine Oxidase是幾種胺類代謝的酵素, 專門氧化代謝5-HT﹐使血清素失效。

哈佛大學畢業的美國女作家Elizabeth Wurtzel著有自傳性的《Prozac Nation: Young and Depressed in America: A Memoir》一書﹐訴說美國年輕新一代 Generation X生活中精神上的掙扎。PROZAC NATION這本暢銷書也被改成電影劇本拍攝﹐將在2002年5月推出上映。改變自原著的同名電影片由 Christina Ricci飾演Elizabeth Wurtzel本人﹐而美國派《American Pie》片中在廚房拿蘋果派作實驗﹐臨陣磨槍時還被爸爸抓包的吉米Jason Biggs飾演Wurtzel的男友。

PROZAC NATION 電影影評網址http://www.upcomingmovies.com/prozacnation.html
PROZAC NATION一書網路書評http://www.thei.aust.com/isite/btl/btlrvprozac.html

CNN.com 網站2002年1月22日專訪PROZAC NATION女作家
Elizabeth Wurtzel﹐談她的最新著作 ”MORE, NOW, AGAIN”
http://asia.cnn.com/2002/SHOWBIZ/books/01/17/wurtzel.cnna/

她的另一著作《BITCH》有中譯本http://www.crown.com.tw/Crown_form_show.asp?StrNo=2220

Eli Lilly 藥廠有關PROZAC的資訊網站
http://www.prozac.com/
Glaxo-Smithkline 藥廠有關PAXIL的資訊網站
http://www.paxil.com/
Pfizer 藥廠有關ZOLOFT的資訊網站
http://www.zoloft.com/

上述資料只供參考﹐治療憂鬱症的藥物未經專業醫生症斷及建議處方下﹐絕對不可自行服用。

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