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Sunday, June 8th, 2008 周日， 2008年6月8日

By通过 MARK THOMPSON马克汤普森 | Seven months after Sergeant Christopher LeJeune started scouting Baghdad’s dangerous roads — acting as bait to lure insurgents into the open so his Army unit could kill them — he found himself growing increasingly despondent. |七个月后，警长克里斯托弗lejeune开始物色巴格达的危险的道路-代理为诱饵，以吸引武装分子进入开放，使他的部队可以杀死他们-他发现自己越来越沮丧。 “We’d been doing some heavy missions, and things were starting to bother me,” LeJeune says. “我们要一直做一些沉重的使命，事情开始困扰着我， ” lejeune说。

His unit had been protecting Iraqi police stations targeted by rocket-propelled grenades, hunting down mortars hidden in dark Baghdad basements and cleaning up its own messes.他所在的部队已被保护的伊拉克警察站所针对的火箭助推榴弹，迫击炮追捕隐藏在黑暗的地下室巴格达和清理自己的餐厅。 He recalls the order his unit got after a nighttime firefight to roll back out and collect the enemy dead.他回忆说该命令他所在的部队得到后，夜间枪战回滚出来，并收集敌方死亡。 When LeJeune and his buddies arrived, they discovered that some of the bodies were still alive.当lejeune和他的朋友抵达，他们发现，有些尸体还活着。 “You don’t always know who the bad guys are,” he says. “你并不总是知道谁是坏人， ”他说。 “When you search someone’s house, you have it built up in your mind that these guys are terrorists, but when you go in, there’s little bitty tiny shoes and toys on the floor — things like that started affecting me a lot more than I thought they would.” “当你搜寻某人的房子，你有它建立在您的心目中，这些家伙是恐怖分子，但是当您在，没有什么bitty小鞋和玩具在地板上-东西一样，开始影响我很多比我更认为他们会“ 。

So LeJeune visited a military doctor in Iraq, who, after a quick session, diagnosed depression.因此， lejeune参观了军医在伊拉克，谁后，快速会议，诊断为抑郁症。 The doctor sent him back to war armed with the antidepressant Zoloft and the antianxiety drug clonazepam.医生送他回战争的武装与抗抑郁药左洛复和抗焦虑药物氯硝西泮。 “It’s not easy for soldiers to admit the problems that they’re having over there for a variety of reasons,” LeJeune says. “这不是一件容易的士兵承认的问题，他们遇到了在那里，出于各种原因， ” lejeune说。 “If they do admit it, then the only solution given is pills.” “如果他们承认，那么唯一的解决办法是，丸” 。

While the headline-grabbing weapons in this war have been high-tech wonders, like unmanned drones that drop Hellfire missiles on the enemy below, troops like LeJeune are going into battle with a different kind of weapon, one so stealthy that few Americans even know of its deployment.而标题触目的武器在这场战争中已高科技奇迹一样，无人认为，无人驾驶飞机下降地狱火导弹对敌人的下面，部队一样， lejeune准备投入战斗，与不同种类的武器之一，因此，隐身，很少美国人知道，甚至其部署。 For the first time in history, a sizable and growing number of US combat troops are taking daily doses of antidepressants to calm nerves strained by repeated and lengthy tours in Iraq and Afghanistan.为在历史上第一次，一个庞大的和越来越多的美国作战部队正在采取每日剂量的抗抑郁药，以冷静，神经紧张，反复和长时间的旅行团在伊拉克和阿富汗。 The medicines are intended not only to help troops keep their cool but also to enable the already strapped Army to preserve its most precious resource: soldiers on the front lines.药物不单帮助部队保持冷静，但也使已经紧张，军队，以维护其最宝贵的资源：士兵上前线。 Data contained in the Army’s fifth Mental Health Advisory Team report indicate that, according to an anonymous survey of US troops taken last fall, about 12% of combat troops in Iraq and 17% of those in Afghanistan are taking prescription antidepressants or sleeping pills to help them cope.中所载的数据军队的第五次心理健康咨询小组的报告表明，据一位匿名的调查，美军所采取的去年秋天，大约有12 ％的作战部队在伊拉克和17 ％的人在阿富汗采取的处方抗抑郁药或安眠药以帮助他们应付。 Escalating violence in Afghanistan and the more isolated mission have driven troops to rely more on medication there than in Iraq, military officials say.不断升级的暴力在阿富汗和更加孤立的使命带动部队更多地依靠药物有比在伊拉克，军方官员说。

At a Pentagon that keeps statistics on just about everything, there is no central clearinghouse for this kind of data, and the Army hasn’t consistently asked about prescription-drug use, which makes it difficult to track.在五角大楼的统计数字，不断对刚才一切，有没有一个中央结算所为，这种数据，和军队没有一贯询问处方药物使用，这使得它难以追踪。 Given the traditional stigma associated with soldiers seeking mental help, the survey, released in March, probably underestimates antidepressant use.鉴于传统的耻辱与士兵寻求心理帮助，调查结果显示， 3月公布，可能是低估了抗抑郁药的使用。 But if the Army numbers reflect those of other services — the Army has by far the most troops deployed to the war zones — about 20,000 troops in Afghanistan and Iraq were on such medications last fall.但如果军队数字反映了相对于其他服务-陆军迄今最部队部署到战区-约2 0 000部队在阿富汗和伊拉克分别就这些药物在去年秋天。 The Army estimates that authorized drug use splits roughly fifty-fifty between troops taking antidepressants — largely the class of drugs that includes Prozac and Zoloft — and those taking prescription sleeping pills like Ambien.军队估计，授权使用药物的分裂大约50 - 50之间的部队以抗抑郁药-主要是类药物，包括百忧解和左洛复-和那些以处方安眠药一样，A m bien。

In some ways, the prescriptions may seem unremarkable.在某些方面，处方可能似乎平凡。 Generals, history shows, have plied their troops with medicinal palliatives at least since George Washington ordered rum rations at Valley Forge.将军，历史表明，有股部队与药用治标不治本，至少自乔治华盛顿下令朗姆酒口粮谷开拓。 During World War II, the Nazis fueled their blitzkrieg into France and Poland with the help of an amphetamine known as Pervitin.二战期间，纳粹闪电战，刺激了他们到法国和波兰与帮助一安非他明被称为脱氧麻黄碱。 The US Army also used amphetamines during the Vietnam War.美军还使用安非他明在越南战争期间。

The military’s rising use of antidepressants also reflects their prevalence in the civilian population.军事的崛起使用抗抑郁药也反映了他们的患病率在平民人口。 In 2004, the last year for which complete data for the US are available, doctors wrote 147 million prescriptions for antidepressants, according to IMS Health, a pharmaceutical-market-research firm.在2004年，去年为完整的数据，为美国的情况下，医生写道147000000处方抗抑郁药物，根据IMS健康，医药市场研究公司。 This number reflects in part the common practice of cycling through different medications to find the most effective drug.这个数字，部分反映共同的做法，骑自行车通过不同的药物，以找到最有效的药物。 A 2006 federally funded study found that 70% of those taking antidepressants along with therapy experience some improvement in mood. 2006年由联邦政府资助的研究发现， 70 ％的那些以抗抑郁药物，随着治疗的经验，一些改善，在情绪。

When it comes to fighting wars, though, troops have historically been barred from using such drugs in combat.当谈到战争，虽然部队已在历史上被禁止使用这类药物在战斗中。 And soldiers — who are younger and healthier on average than the general population — have been prescreened for mental illnesses before enlisting.官兵-谁是年轻和健康，平均比一般人口-已p r escreened为精神病之前争取。

The increase in the use of medication among US troops suggests the heavy mental and psychological price being paid by soldiers fighting in Iraq and Afghanistan.增加在使用药物之间的美军表明，沉重的精神和心理的价格支付士兵的战斗在伊拉克和阿富汗。 Pentagon surveys show that while all soldiers deployed to a war zone will feel stressed, 70% will manage to bounce back to normalcy.五角大楼的调查结果显示，虽然所有的士兵部署到战区会觉得强调， 70 ％将设法退回到正常状态。 But about 20% will suffer from what the military calls “temporary stress injuries,” and 10% will be afflicted with “stress illnesses.” Such ailments, according to briefings commanders get before deploying, begin with mild anxiety and irritability, difficulty sleeping, and growing feelings of apathy and pessimism.但是，大约20 ％将受到什么军事呼吁“临时压力伤害， ”和10 ％ ，将遭受“应力疾病。 ”这种疾病，据介绍指挥官获得前部署，开始轻度的焦虑和烦躁不安，睡眠困难，和越来越多的感情，冷漠和悲观。 As the condition worsens, the feelings last longer and can come to include panic, rage, uncontrolled shaking and temporary paralysis.作为条件进一步恶化，感情的最后时间更长，可以来，包括恐慌，愤怒，不受控制的摇头和暂时性瘫痪。 The symptoms often continue back home, playing a key role in broken marriages, suicides and psychiatric breakdowns.症状往往继续回到家里，发挥了关键作用，在破碎的婚姻，自杀和精神病的分项数字。 The mental trauma has become so common that the Pentagon may expand the list of “qualifying wounds” for a Purple Heart — historically limited to those physically injured on the battlefield — to include posttraumatic stress disorder (PTSD).心理的创伤，已成为如此普遍表示，五角大厦可能扩大的名单“合资格的伤口”一个紫心勋章-历史上只限于那些肢体受伤在战场上-包括创伤后应激障碍（创伤后应激障碍）。 Defense Secretary Robert Gates said on May 2 that it’s “clearly something” that needs to be considered, and the Pentagon is weighing the change.国防部长罗伯特盖茨说， 5月2日，它的“显然”需要考虑的，五角大楼正在权衡改变。

Using drugs to cope with battlefield traumas is not discussed much outside the Army, but inside the service it has been the subject of debate for years.使用药物，以应付战场上的创伤是没有讨论过很多以外的军队，但里面的服务一直是辩论的主题为年。 “No magic pill can erase the image of a best friend’s shattered body or assuage the guilt from having traded duty with him that day,” says Combat Stress Injury , a 2006 medical book edited by Charles Figley and William Nash that details how troops can be helped by such drugs. “没有魔术丸可以擦除的形象，一个最好的朋友的破灭机构或安抚有罪有交易税，与他那一天，说： ” 战斗应激损伤 ， 2006年医学图书编辑菲格利查尔斯和威廉纳什的细节如何部队可以帮助这类药物。 “Medication can, however, alleviate some debilitating and nearly intolerable symptoms of combat and operational stress injuries” and “help restore personnel to full functioning capacity.” “服药可以，不过，纾缓一些衰弱和近难以忍受的症状，打击和业务压力伤害”和“帮助恢复人员充分运作的能力” 。

Which means that any drug that keeps a soldier deployed and fighting also saves money on training and deploying replacements.这意味着任何药物不断一名士兵部署和战斗力，也节省金钱的训练和部署的替代。 But there is a downside: the number of soldiers requiring long-term mental-health services soars with repeated deployments and lengthy combat tours.但有一个缺点：士兵人数需要长期的心理健康服务的猛增，与反复的部署和冗长的战斗之旅。 If troops do not get sufficient time away from combat — both while in theater and during the “dwell time” at home before they go back to war — it’s possible that antidepressants and sleeping aids will be used to stretch an already taut force even tighter.如果军队没有得到足够的时间远离作战-而在这两个战区，并在“停留时间”在家里之前，他们回去的战争-这可能是抗抑郁药和睡艾滋病将被用来舒展已经绷紧的力量，甚至严格的。 “This is what happens when you try to fight a long war with an army that wasn’t designed for a long war,” says Lawrence Korb, Pentagon personnel chief during the Reagan Administration. “这是发生什么事，当您尝试打一场长期的战争与军队，这是不是设计一个长期的战争， ”劳伦斯科布说，五角大楼工作人员行政里根政府时期。

Military families wonder about the change, according to Joyce Raezer of the private National Military Family Association.军人家属怀疑的变化，根据乔伊斯raezer的私营全国军人家庭协会。 “Boy, it’s really nice to have these drugs,” she recalls a military doctor saying, “so we can keep people deployed.” And professionals have their doubts. “男孩，这真是好有这些药物， ”她回忆军事医生说， “所以我们能保持人民部署。 ”及专业人士有他们的疑虑。 “Are we trying to bandage up what is essentially an insufficient fighting force?” asks Dr. Frank Ochberg, a veteran psychiatrist and founding board member of the International Society for Traumatic Stress Studies. “我们试图绷带了什么是本质上是一个不足的战斗力” ？问弗兰克医生ochberg ，一位资深的精神科医生和成立董事会的成员之一，国际创伤压力研究学会。

Such questions have assumed greater urgency as more is revealed about the side effects of some mental-health medications.这些问题承担更大的紧迫性更是透露，有关的副作用，一些心理健康的药品。 Last year the US Food and Drug Administration (FDA) urged the makers of antidepressants to expand a 2004 “black box” warning that the drugs may increase the risk of suicide in children and adolescents.去年，美国食品和药物管理局（ FDA ）敦促决策者抗抑郁药，以扩大2004年“黑匣子”警告说，药物可能会增加自杀的危险在儿童和青少年。 The agency asked for — and got — an expanded warning that included young adults ages 18 to 24, the age group at the heart of the Army.该机构要求-得到-扩大警告说，包括年轻的成年人年龄18日至2 4日，该年龄组中处于核心地位的军队。 The question now is whether there is a link between the increased use of the drugs in the Iraqi and Afghan theaters and the rising suicide rate in those places.现在的问题是，是否有之间的联系越来越多地使用药物，在伊拉克和阿富汗战区和上升的自杀率在这些地方。 There have been 164 Army suicides in Afghanistan and Iraq from the wars’ start through 2007, and the annual rate there is now double the service’s 2001 rate.有164自杀军队在阿富汗和伊拉克从战争'开始到2007年，每年有率是现在的两倍，服务的2001年率。

At least 115 soldiers killed themselves last year, including 36 in Iraq and Afghanistan, the Army said on May 29.至少115名自己去年，包括36个在伊拉克和阿富汗，军方说， 5月29日。 That’s the highest toll since it started keeping such records in 1980.这是最高的收费，因为它开始保持这种记录在1980年。 Nearly 40% of Army suicide victims in 2006 and 2007 took psychotropic drugs — overwhelmingly, selective serotonin reuptake inhibitors (SSRIs) like Prozac and Zoloft.近40 ％的军队自杀的受害者在2006年和2007年采取了精神科药物-以压倒多数，选择性血清素再吸收抑制剂（ s sris）一样，百忧解和左洛复。 While the Army cites failed relationships as the primary cause, some outside experts sense a link between suicides and prescription-drug use — though there is also no way of knowing how many suicide attempts the antidepressants may have prevented by improving a soldier’s spirits.而军队的濒危物种贸易公约失败的关系作为首要的原因，一些外界专家的意识之间的桥梁，自杀和处方药物使用的-虽然也有无从得知有多少企图自杀的抗抑郁药可能有预防改善士兵的精神。 “The high percentage of US soldiers attempting suicide after taking SSRIs should raise serious concerns,” says Dr. Joseph Glenmullen, who teaches psychiatry at Harvard Medical School. “高比例的美军士兵企图自杀和自杀后， ssris应该引起严重关切，博士说： ”约瑟夫glenmullen ，谁教精神病学哈佛医学院。 “And there’s no question they’re using them to prop people up in difficult circumstances.” “有是毫无疑问的，他们正在使用他们版权的人在困难的情况下” 。

The Trauma of War 战争创伤
Before the advent of SSRIs — Lilly’s Prozac was the first to be approved by the FDA, in 1987, followed by Zoloft from Pfizer, Paxil from GlaxoSmithKline, Celexa from Forest Pharmaceuticals and others — existing antidepressants had many disabling side effects.之前的来临， ssris -礼来的百忧解是第一家经美国食品药品管理局，于1 987年，其次是左洛复，从辉瑞，帕罗西汀，由葛兰素史克公司， c elexa从森林的药品和其他人-现有的抗抑郁药有很多禁用的副作用。 Impaired memory and judgment, dizziness, drowsiness and other complications made them ill suited for troops in combat.受损的记忆和判断能力，晕眩，昏睡及其他并发症，使他们生病适合部队在作战。 The newer drugs have fewer side effects and, unlike earlier drugs, are generally not addictive or toxic, even when taken in large quantities.较新的药物有副作用，不同于先前的药物，一般都不会上瘾或有毒的，即使在采取的大量。 They work by keeping neural connections bathed in a brain chemical known as serotonin.他们的工作，保持神经连接沐浴在脑化学称为羟色胺。 That amplifies serotonin’s mood-brightening effect, at least for some people.扩大羟色胺的情绪-光亮的效果，至少对某些人来说。

In 1994 then Major E. Cameron Ritchie, an Army psychiatrist, was among the first to suggest that SSRIs should deploy with Army combat units.在1994年，然后主要e.金马伦瑞奇，一个军队精神科医生，是最早建议ssris要部署军队作战部队。 In a paper written and published after she returned from a combat deployment to Somalia, Ritchie noted that the sick-call chests used by military doctors “contain either outdated or no psychiatric medications.” She concluded, “If depressive symptoms are moderate and manageable, medication may be preferable to medical evacuation.”在一份文件中的书面和出版后，她回到从作战部署到索马里，瑞奇指出，有病通话胸前，用军事医生“包含过时或没有精神科药物， ”她总结说： “如果抑郁症状是温和的和易于管理，药物治疗可能更为可取，以医疗后送“ 。

By 1999, military docs were debating the matter among themselves.到1999年，军事文件辩论此事，在它们之间。 Nash, a Navy psychiatrist, wrote that Navy doctors — who also provide Marines with medical care — had “sharp differences of opinion” over letting troops in war zones use SSRIs.纳什，海军某精神科医生撰文指出，海军医生-谁也提供海军陆战队与医疗服务- “尖锐的意见分歧”，让部队在战争地区使用ss ris。 Skeptics argued that their “real safety” in combat had not been proved.怀疑论者认为，他们的“真正的安全”在战斗中还没有得到证实。 Supporters countered that their use could “avoid depleting manpower resources and damaging individual careers through unnecessary removals from operational duty.” Nash reviewed the medical literature and reported that SSRIs “can be safely administered to deploying and deployed personnel.”支持者反击说，他们可以利用“ ，避免消耗的人力资源和损害个人择业通过清除不必要的业务责任。 ”纳什审查医学文献和报道， ssris “可以安全管理的部署和部署人员” 。

The trickle of new drugs became a flood after the invasion of Iraq in 2003.涓流的新药物，成为洪水后， 2003年入侵伊拉克。 Details of America’s medicated wars come from the mental-health surveys the Army has conducted each year since the war began.详情美国的战争药来自心理健康状况的调查，陆军每年进行自战争开始。 If the surveys are right, many US soldiers experience a common but haunting mismatch in combat life: while nearly two-thirds of the soldiers surveyed in Iraq in 2006 knew someone who had been killed or wounded, fewer than 15% knew for certain that they had actually killed a member of the enemy in return.如果调查结果是正确的，许多美国士兵的经验，一个共同的困扰，但错配的作战生活：虽然将近三分之二的接受调查的士兵在伊拉克在2006年，有人知道谁已被打死或受伤，只有不到15 ％ ，知道肯定他们实际上已杀害了一名成员，敌人的回报。 That imbalance between seeing the price of war up close and yet not feeling able to do much about it, the survey suggests, contributes to feelings of “intense fear, helplessness or horror” that plant the seeds of mental distress.这之间的不平衡看到战争的代价了密切的和尚未感觉，能够做到的不多，该调查显示，有助于感情的“激烈的恐惧，无助或恐怖的”植物的种子，精神困扰。 “A friend was liquefied in the driver’s position on a tank, and I saw everything,” was a typical comment. “朋友是液化在司机的立场，坦克，和我看到的一切， ”是一个典型的评论。 Another: “A huge f______ bomb blew my friend’s head off like 50 meters from me.” Such indelible scenes — and wondering when and where the next one will happen — are driving thousands of soldiers to take antidepressants, military psychiatrists say.另一个说： “一个巨大f______就发生了爆炸我的朋友的头一样， 50米，从我”等了不可磨灭的场面-不知道何时，何地在未来一会发生什么-是驾驶数以千计的军人采取抗抑郁药，军事精神科医生说。 It’s not hard to imagine why.这是不难想象为何。

Repeated deployments to the war zones also contribute to the onset of mental-health problems.反复部署战区也有助于出现心理健康问题。 Nearly 30% of troops on their third deployment suffer from serious mental-health problems, a top Army psychiatrist told Congress in March.近30 ％的部队对他们的第三次部署遭受严重的心理健康问题，一位陆军精神科医生告诉国会在三月。 The doctor, Colonel Charles Hoge, added that recent research has shown the current 12 months between combat tours “is insufficient time” for soldiers “to reset” and recover from the stress of a combat tour before heading back to war.医生，上校查尔斯hoge补充说，最近的研究表明目前的12个月之间的战斗之旅“是不足够的时间”为兵“重置” ，并收回由应力是一个战斗旅抽穗前回到战争。

Colonel Joseph Horam says antidepressants have made “a striking difference” in the way troops are treated in war.上校约瑟夫霍拉姆说，抗抑郁药已取得了“惊人的差异： ”在部队的方式处理在战争中。 A doctor in the Wyoming Army National Guard, Horam served in Saudi Arabia during the first Gulf War and has been deployed to Iraq twice during this war.一名医生，在怀俄明州的陆军国民警卫队，霍拉姆服务在沙特阿拉伯的第一次海湾战争期间，并已部署到伊拉克的两倍，在这场战争中。 “In the Persian Gulf War, we didn’t have these medications, so our basic philosophy was ‘three hots and a cot’” — giving stressed troops a little rest and relaxation to see if they improved. ： “在波斯湾战争，我们没有这些药物，所以我们的基本宗旨是'三hots和摇篮” -让强调，部队一点休息和放松，看看是否有所改善。 “If they didn’t get better right away, they’d need to head to the rear and probably out of theater.” But in his most recent stint in Baghdad in 2006, he treated a soldier who guarded Iraqi detainees. “如果他们没有得到更好的权利以外，他们要需要头后方可能走出剧场” ，但在他最近不惜在巴格达在2006年，他对待一名士兵谁森严的伊拉克战俘。 “He was distraught while he was having high-level interactions with detainees, having emotional confrontations with them — and carrying weapons,” Horam says. “他是悲痛，虽然他有高层次的互动与被拘留后，情绪对抗，与他们-和携带武器， ”霍拉姆说。 “But he was part of a highly trained team, and we didn’t want to lose him. “但他的一个组成部分，受过高度训练的球队，我们不想失去他。 So we put him on an SSRI, and within a week, he was a new person, and we got him back to full duty.”因此，我们把他一ssri ，并在一个星期内，他是一个全新的人了，我们回到了他的全部责任“ 。

It wasn’t until November 2006 that the Pentagon set a uniform policy for all the services.但直到2006年11月说，五角大楼成立一个统一的政策，所有的服务。 But the curious thing about it was that it didn’t mention the new antidepressants.但奇怪的事情，这是它并没有提到新的抗抑郁药。 Instead, it simply barred troops from taking older drugs, including “lithium, anticonvulsants and antipsychotics.” The goal, a participant in crafting the policy said, was to give SSRIs a “green light” without saying so.相反，它只是禁止从部队采取较旧的毒品，包括“锂，抗惊厥药和抗精神病药物。 ”我们的目标，一位与会者在制定政策说，这是给ssris了“绿灯”没有这样说。 Last July, a paper published by three military psychiatrists in Military Medicine , the independent journal of the Association of Military Surgeons of the United States, urged military doctors headed for Afghanistan and Iraq to “request a considerable quantity of the SSRI they are most comfortable prescribing” for the “treatment of new-onset depressive disorders” once in the war zones.去年7月，一份文件，公布三名军事精神科医生在军事医学 ，独立的Journal of the协会军事外科医生的美国，敦促军事医生为首的为阿富汗和伊拉克“的要求，相当数量的ssri他们是最舒服的处方“ ”治疗新发病的抑郁症“ ，一旦在战争中区。 The medications, the doctors concluded, help “to ‘conserve the fighting strength,’” the motto of the Army Medical Corps.药物，医生的结论是，帮助“ '保存战力， ”为口号，军队医疗团。

These days Ritchie — now a colonel and a psychiatric consultant to the Army surgeon general — thinks the military’s use of SSRIs has helped destigmatize mental problems.这些天瑞奇-现在的一名上校和精神科顾问，军队外科医生一般-认为，军队的使用ss ris帮助de stigmatize精神问题。 “What we’re trying to do is make treating depression and PTSD — especially PTSD, which is quite common for soldiers now — fairly routine,” she says. “我们正在试图做的是使治疗抑郁症和创伤后应激障碍-尤其是创伤后应激障碍，这是相当普遍的士兵现在-相当例行的， ”她说。 “We don’t want to make it harder for folks to do their job and their mission by saying they can’t use these medications.” Ritchie, who communicates “six times a day” with her colleagues in the war zones, says she is unaware of “any bad outcomes” resulting from soldiers taking SSRIs. “我们不希望把它更难的乡亲做他们的工作和他们的使命说，他们无法使用这些药物。 ”瑞奇，谁沟通“的6倍，每天”与她的同事们在战争中区，说，她不知道“任何坏的结果”所造成的士兵采取ssris 。

William Winkenwerder Jr., who issued the 2006 policy as the Pentagon’s top doctor before stepping down last year, says the new medicines are working well.威廉温肯韦尔德小，谁发出的2006年的政策，作为五角大楼的顶端医生之前下台，去年说，新的药物，运作良好。 “Combat presents some unique and important caveats — obviously, those who are being treated have access to firearms, and they may be under significant stress, so they need to be very carefully evaluated, and good clinical decisions need to be made,” Winkenwerder tells TIME. “作战提出了一些独特而重要的变数-显然，那些谁正在接受治疗的获得枪支，他们可能受到重大压力，所以他们必须非常仔细地评估，和良好的临床决定需要作出的， ”温肯韦尔德告诉时间。 “It’s my belief that is happening.” “这是我的信念正在发生的事情” 。

“In a Total Daze” “在一个总泽”
And yet the battlefield seems an imperfect environment for widespread prescription of these medicines.然而，战场上似乎是一个不完美的环境，广泛的处方这些药物。 LeJeune, who spent 15 months in Iraq before returning home in May 2004, says many more troops need help — pharmaceutical or otherwise — but don’t get it because of fears that it will hurt their chance for promotion. lejeune ，谁花了15个月，在伊拉克前回家，在2004年5月，说，许多更需要帮助的部队-药剂或以其他方式-但不得到它，因为担心它会伤害他们的机会晋升。 “They don’t want to destroy their career or make everybody go in a convoy to pick up your prescription,” says LeJeune, now 34 and living in Utah. “他们不想破坏他们的职业或让大家去在一个车队，以拿起你的药方，说： ” lejeune ，现在34和住在犹他州。 “In the civilian world, when you have a problem, you go to the doctor, and you have therapy followed up by some medication. “在平民世界，当你有一个问题，你去看医生，和你有治疗的跟进，一些药物治疗。 In Iraq, you see the doctor only once or twice, but you continue to get drugs constantly.” LeJeune says the medications — combined with the war’s other stressors — created unfit soldiers.在伊拉克，你看医生，只有一次或两次，但你继续得到药物而不断“ 。 lejeune说，药物-结合战争的其他压力-创造不适宜士兵。 “There were more than a few convoys going out in a total daze.” “有更多的比数车队走出去，在共泽” 。

About a third of soldiers in Afghanistan and Iraq say they can’t see a mental-health professional when they need to.大约三分之一的士兵在阿富汗和伊拉克说，他们不能看到一个心理健康的专业，当他们需要。 When the number of troops in Iraq surged by 30,000 last year, the number of Army mental-health workers remained the same — about 200 — making counseling and care even tougher to get.当数量的部队在伊拉克的激增3.0万，去年有多少军队心理健康的工人仍然是相同的-约2 00名-决策辅导和照顾，甚至更严厉的获得。

“Burnout and compassion fatigue” are rising among such personnel, and there have been “recent psychiatric evacuations” of Army mental-health workers from Iraq, the 2007 survey says. “倦怠和同情疲劳症”不断上升，这些人员，并有“最近精神科后送”军队心理卫生工作者从伊拉克撤军， 2007年的调查说。 Soldiers are often stationed at outposts so isolated that follow-up visits with counselors are difficult.士兵往往是驻扎在前哨，使孤立的后续访问与辅导员是困难。 “In a perfect world,” admits Nash, who has just retired from the Navy, “you would not want to rely on medications as your first-line treatment, but in deployed settings, that is often all you have.” “在一个完美的世界， ”纳什承认，谁刚刚退休的来自海军， “你不会要依赖于药物作为您的第一线治疗，但在部署的设置，往往是你有所有” 。

And just as more troops are taking these drugs, there are new doubts about the drugs’ effectiveness.正如更多的部队正在这些药物，有新的疑虑，有关药物的有效性。 A pair of recent reports from Rand and the federal Institute of Medicine (iom) raise doubts about just how much the new medicines can do to alleviate PTSD.一对最近的报告由兰德公司和联邦医学研究院（移徙组织）提出质疑，只是多少新药物可以做，以减轻创伤后应激障碍。 The Rand study, released in April, says the “overall effects for SSRIs, even in the largest clinical trials, are modest.” Last October the iom concluded, “The evidence is inadequate to determine the efficacy of SSRIs in the treatment of PTSD.”兰德研究，发表在4月表示， “整体的效果， ssris ，即使在最大的临床试验，是温和的” 。去年10月，国际移民组织的结论， “证据不足，以确定疗效ssris在治疗创伤后应激障碍。 “

Chris LeJeune could have told them that.克里斯lejeune可以告诉他们。 When he returned home in May 2004, he remained on clonazepam and other drugs.当他回国以后，在2004年5月，他仍然对氯硝西泮与其他药物。 He became one of 300,000 Americans who served in Iraq and Afghanistan and suffer from PTSD or depression.他成为一个美国人300000谁曾任职于伊拉克和阿富汗遭受创伤后应激障碍或抑郁症。 “But PTSD isn’t fixed by taking pills — it’s just numbed,” he claims now. “创伤后应激障碍，但并不固定以药丸-这只是麻木，他声称： ”现在。 “And I felt like I was drugged all the time.” So a year ago, he simply stopped taking them. “我觉得自己被麻醉的所有时间。 ”因此，一年前，他干脆停止服用。 “I just started trying to fight my demons myself,” he says, with help from VA counseling. “我刚开始试图扑灭我的魔自己， ”他说，帮助VA部辅导。 He laughs when asked how he’s doing.他笑说，当记者问他如何做。 “I’d like to think,” he says, “that I’m really damn close back to normal.” “我想认为， ”他说， “我真的可恶接近恢复正常” 。

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