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Sunday, June 8th, 2008 週日， 2008年6月8日

By通過 MARK THOMPSON馬克湯普森 | 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. |七個月後，警長克里斯托弗lejeune開始物色巴格達的危險的道路-代理為誘餌，以吸引武裝分子進入開放，使他的部隊可以殺死他們-他發現自己越來越沮喪。 “We’d been doing some heavy missions, and things were starting to bother me,” LeJeune says. “我們要一直做一些沉重的使命，事情開始困擾著我， ” lejeune說。

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.他所在的部隊已被保護的伊拉克警察站所針對的火箭助推榴彈，迫擊砲追捕隱藏在黑暗的地下室巴格達和清理自己的餐廳。 He recalls the order his unit got after a nighttime firefight to roll back out and collect the enemy dead.他回憶說該命令他所在的部隊得到後，夜間槍戰回滾出來，並收集敵方死亡。 When LeJeune and his buddies arrived, they discovered that some of the bodies were still alive.當lejeune和他的朋友抵達，他們發現，有些屍體還活著。 “You don’t always know who the bad guys are,” he says. “你並不總是知道誰是壞人， ”他說。 “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.” “當你搜尋某人的房子，你有它建立在您的心目中，這些傢伙是恐怖分子，但是當您在，沒有什麼bitty小鞋和玩具在地板上-東西一樣，開始影響我很多比我更認為他們會“ 。

So LeJeune visited a military doctor in Iraq, who, after a quick session, diagnosed depression.因此， lejeune參觀了軍醫在伊拉克，誰後，快速會議，診斷為抑鬱症。 The doctor sent him back to war armed with the antidepressant Zoloft and the antianxiety drug clonazepam.醫生送他回戰爭的武裝與抗抑鬱藥左洛复和抗焦慮藥物氯硝西泮。 “It’s not easy for soldiers to admit the problems that they’re having over there for a variety of reasons,” LeJeune says. “這不是一件容易的士兵承認的問題，他們遇到了在那裡，出於各種原因， ” lejeune說。 “If they do admit it, then the only solution given is pills.” “如果他們承認，那麼唯一的解決辦法是，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.而標題觸目的武器在這場戰爭中已高科技奇蹟一樣，無人認為，無人駕駛飛機下降地獄火導彈對敵人的下面，部隊一樣， lejeune準備投入戰鬥，與不同種類的武器之一，因此，隱身，很少美國人知道，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.為在歷史上第一次，一個龐大的和越來越多的美國作戰部隊正在採取每日劑量的抗抑鬱藥，以冷靜，神經緊張，反复和長時間的旅行團在伊拉克和阿富汗。 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.藥物不單幫助部隊保持冷靜，但也使已經緊張，軍隊，以維護其最寶貴的資源：士兵上前線。 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.中所載的數據軍隊的第五次心理健康諮詢小組的報告表明，據一位匿名的調查，美軍所採取的去年秋天，大約有12 ％的作戰部隊在伊拉克和17 ％的人在阿富汗採取的處方抗抑鬱藥或安眠藥以幫助他們應付。 Escalating violence in Afghanistan and the more isolated mission have driven troops to rely more on medication there than in Iraq, military officials say.不斷升級的暴力在阿富汗和更加孤立的使命帶動部隊更多地依靠藥物有比在伊拉克，軍方官員說。

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.在五角大樓的統計數字，不斷對剛才一切，有沒有一個中央結算所為，這種數據，和軍隊沒有一貫詢問處方藥物使用，這使得它難以追踪。 Given the traditional stigma associated with soldiers seeking mental help, the survey, released in March, probably underestimates antidepressant use.鑑於傳統的恥辱與士兵尋求心理幫助，調查結果顯示， 3月公佈，可能是低估了抗抑鬱藥的使用。 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.但如果軍隊數字反映了相對於其他服務-陸軍迄今最部隊部署到戰區-約2 0 000部隊在阿富汗和伊拉克分別就這些藥物在去年秋天。 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.軍隊估計，授權使用藥物的分裂大約50 - 50之間的部隊以抗抑鬱藥-主要是類藥物，包括百憂解和左洛复-和那些以處方安眠藥一樣，A m bien。

In some ways, the prescriptions may seem unremarkable.在某些方面，處方可能似乎平凡。 Generals, history shows, have plied their troops with medicinal palliatives at least since George Washington ordered rum rations at Valley Forge.將軍，歷史表明，有股部隊與藥用治標不治本，至少自喬治華盛頓下令朗姆酒口糧谷開拓。 During World War II, the Nazis fueled their blitzkrieg into France and Poland with the help of an amphetamine known as Pervitin.二戰期間，納粹閃電戰，刺激了他們到法國和波蘭與幫助一安非他明被稱為脫氧麻黃鹼。 The US Army also used amphetamines during the Vietnam War.美軍還使用安非他明在越南戰爭期間。

The military’s rising use of antidepressants also reflects their prevalence in the civilian population.軍事的崛起使用抗抑鬱藥也反映了他們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，去年為完整的數據，為美國的情況下，醫生寫道147000000處方抗抑鬱藥物，根據IMS健康，醫藥市場研究公司。 This number reflects in part the common practice of cycling through different medications to find the most effective drug.這個數字，部分反映共同的做法，騎自行車通過不同的藥物，以找到最有效的藥物。 A 2006 federally funded study found that 70% of those taking antidepressants along with therapy experience some improvement in mood. 2006年由聯邦政府資助的研究發現， 70 ％的那些以抗抑鬱藥物，隨著治療的經驗，一些改善，在情緒。

When it comes to fighting wars, though, troops have historically been barred from using such drugs in combat.當談到戰爭，雖然部隊已在歷史上被禁止使用這類藥物在戰鬥中。 And soldiers — who are younger and healthier on average than the general population — have been prescreened for mental illnesses before enlisting.官兵-誰是年輕和健康，平均比一般人口-已p r escreened為精神病之前爭取。

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.增加在使用藥物之間的美軍表明，沉重的精神和心理的價格支付士兵的戰鬥在伊拉克和阿富汗。 Pentagon surveys show that while all soldiers deployed to a war zone will feel stressed, 70% will manage to bounce back to normalcy.五角大樓的調查結果顯示，雖然所有的士兵部署到戰區會覺得強調， 70 ％將設法退回到正常狀態。 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，大約20 ％將受到什麼軍事呼籲“臨時壓力傷害， ”和10 ％ ，將遭受“應力疾病。 ”這種疾病，據介紹指揮官獲得前部署，開始輕度的焦慮和煩躁不安，睡眠困難，和越來越多的感情，冷漠和悲觀。 As the condition worsens, the feelings last longer and can come to include panic, rage, uncontrolled shaking and temporary paralysis.作為條件進一步惡化，感情的最後時間更長，可以來，包括恐慌，憤怒，不受控制的搖頭和暫時性癱瘓。 The symptoms often continue back home, playing a key role in broken marriages, suicides and psychiatric breakdowns.症狀往往繼續回到家裡，發揮了關鍵作用，在破碎的婚姻，自殺和精神病的分項數字。 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).心理的創傷，已成為如此普遍表示，五角大廈可能擴大的名單“合資格的傷口”一個紫心勳章-歷史上只限於那些肢體受傷在戰場上-包括創傷後應激障礙（創傷後應激障礙）。 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.國防部長羅伯特蓋茨說， 5月2日，它的“顯然”需要考慮的，五角大樓正在權衡改變。

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.使用藥物，以應付戰場上的創傷是沒有討論過很多以外的軍隊，但裡面的服務一直是辯論的主題為年。 “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. “沒有魔術丸可以擦除的形象，一個最好的朋友的破滅機構或安撫有罪有交易稅，與他那一天，說： ” 戰鬥應激損傷 ， 2006年醫學圖書編輯菲格利查爾斯和威廉納什的細節如何部隊可以幫助這類藥物。 “Medication can, however, alleviate some debilitating and nearly intolerable symptoms of combat and operational stress injuries” and “help restore personnel to full functioning capacity.” “服藥可以，不過，紓緩一些衰弱和近難以忍受的症狀，打擊和業務壓力傷害”和“幫助恢復人員充分運作的能力” 。

Which means that any drug that keeps a soldier deployed and fighting also saves money on training and deploying replacements.這意味著任何藥物不斷一名士兵部署和戰鬥力，也節省金錢的訓練和部署的替代。 But there is a downside: the number of soldiers requiring long-term mental-health services soars with repeated deployments and lengthy combat tours.但有一個缺點：士兵人數需要長期的心理健康服務的猛增，與反复的部署和冗長的戰鬥之旅。 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.如果軍隊沒有得到足夠的時間遠離作戰-而在這兩個戰區，並在“停留時間”在家裡之前，他們回去的戰爭-這可能是抗抑鬱藥和睡艾滋病將被用來舒展已經繃緊的力量，甚至嚴格的。 “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. “這是發生什麼事，當您嘗試打一場長期的戰爭與軍隊，這是不是設計一個長期的戰爭， ”勞倫斯科布說，五角大樓工作人員行政裡根政府時期。

Military families wonder about the change, according to Joyce Raezer of the private National Military Family Association.軍人家屬懷疑的變化，根據喬伊斯raezer的私營全國軍人家庭協會。 “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，這真是好有這些藥物， ”她回憶軍事醫生說， “所以我們能保持人民部署。 ”及專業人士有他們的疑慮。 “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. “我們試圖繃帶了什麼是本質上是一個不足的戰鬥力” ？問弗蘭克醫生ochberg ，一位資深的精神科醫生和成立董事會的成員之一，國際創傷壓力研究學會。

Such questions have assumed greater urgency as more is revealed about the side effects of some mental-health medications.這些問題承擔更大的緊迫性更是透露，有關的副作用，一些心理健康的藥品。 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，美國食品和藥物管理局（ FDA ）敦促決策者抗抑鬱藥，以擴大2004年“黑匣子”警告說，藥物可能會增加自殺的危險在兒童和青少年。 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.該機構要求-得到-擴大警告說，包括年輕的成年人年齡18日至2 4日，該年齡組中處於核心地位的軍隊。 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.現在的問題是，是否有之間的聯繫越來越多地使用藥物，在伊拉克和阿富汗戰區和上升的自殺率在這些地方。 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自殺軍隊在阿富汗和伊拉克從戰爭'開始到2007年，每年有率是現在的兩倍，服務的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個在伊拉克和阿富汗，軍方說， 5月29日。 That’s the highest toll since it started keeping such records in 1980.這是最高的收費，因為它開始保持這種記錄在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 ％的軍隊自殺的受害者在2006年和2007年採取了精神科藥物-以壓倒多數，選擇性血清素再吸收抑製劑（ s sris）一樣，百憂解和左洛复。 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.而軍隊的瀕危物種貿易公約失敗的關係作為首要的原因，一些外界專家的意識之間的橋樑，自殺和處方藥物使用的-雖然也有無從得知有多少企圖自殺的抗抑鬱藥可能有預防改善士兵的精神。 “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. “高比例的美軍士兵企圖自殺和自殺後， ssris應該引起嚴重關切，博士說： ”約瑟夫glenmullen ，誰教精神病學哈佛醫學院。 “And there’s no question they’re using them to prop people up in difficult circumstances.” “有是毫無疑問的，他們正在使用他們版權的人在困難的情況下” 。

The Trauma of War 戰爭創傷
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.之前的來臨， ssris -禮來的百憂解是第一家經美國食品藥品管理局，於1 987年，其次是左洛复，從輝瑞，帕羅西汀，由葛蘭素史克公司， c elexa從森林的藥品和其他人-現有的抗抑鬱藥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.受損的記憶和判斷能力，暈眩，昏睡及其他並發症，使他們生病適合部隊在作戰。 The newer drugs have fewer side effects and, unlike earlier drugs, are generally not addictive or toxic, even when taken in large quantities.較新的藥物有副作用，不同於先前的藥物，一般都不會上癮或有毒的，即使在採取的大量。 They work by keeping neural connections bathed in a brain chemical known as serotonin.他們的工作，保持神經連接沐浴在腦化學稱為羥色胺。 That amplifies serotonin’s mood-brightening effect, at least for some people.擴大羥色胺的情緒-光亮的效果，至少對某些人來說。

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，然後主要e.金馬倫瑞奇，一個軍隊精神科醫生，是最早建議ssris要部署軍隊作戰部隊。 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.”在一份文件中的書面和出版後，她回到從作戰部署到索馬里，瑞奇指出，有病通話胸前，用軍事醫生“包含過時或沒有精神科藥物， ”她總結說： “如果抑鬱症狀是溫和的和易於管理，藥物治療可能更為可取，以醫療後送“ 。

By 1999, military docs were debating the matter among themselves.到1999年，軍事文件辯論此事，在它們之間。 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.納什，海軍某精神科醫生撰文指出，海軍醫生-誰也提供海軍陸戰隊與醫療服務- “尖銳的意見分歧”，讓部隊在戰爭地區使用ss ris。 Skeptics argued that their “real safety” in combat had not been proved.懷疑論者認為，他們的“真正的安全”在戰鬥中還沒有得到證實。 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.”支持者反擊說，他們可以利用“ ，避免消耗的人力資源和損害個人擇業通過清除不必要的業務責任。 ”納什審查醫學文獻和報導， ssris “可以安全管理的部署和部署人員” 。

The trickle of new drugs became a flood after the invasion of Iraq in 2003.涓流的新藥物，成為洪水後， 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.詳情美國的戰爭藥來自心理健康狀況的調查，陸軍每年進行自戰爭開始。 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.如果調查結果是正確的，許多美國士兵的經驗，一個共同的困擾，但錯配的作戰生活：雖然將近三分之二的接受調查的士兵在伊拉克在2006年，有人知道誰已被打死或受傷，只有不到15 ％ ，知道肯定他們實際上已殺害了一名成員，敵人的回報。 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.這之間的不平衡看到戰爭的代價了密切的和尚未感覺，能夠做到的不多，該調查顯示，有助於感情的“激烈的恐懼，無助或恐怖的”植物的種子，精神困擾。 “A friend was liquefied in the driver’s position on a tank, and I saw everything,” was a typical comment. “朋友是液化在司機的立場，坦克，和我看到的一切， ”是一個典型的評論。 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.另一個說： “一個巨大f______就發生了爆炸我的朋友的頭一樣， 50米，從我”等了不可磨滅的場面-不知道何時，何地在未來一會發生什麼-是駕駛數以千計的軍人採取抗抑鬱藥，軍事精神科醫生說。 It’s not hard to imagine why.這是不難想像為何。

Repeated deployments to the war zones also contribute to the onset of mental-health problems.反复部署戰區也有助於出現心理健康問題。 Nearly 30% of troops on their third deployment suffer from serious mental-health problems, a top Army psychiatrist told Congress in March.近30 ％的部隊對他們的第三次部署遭受嚴重的心理健康問題，一位陸軍精神科醫生告訴國會在三月。 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.醫生，上校查爾斯hoge補充說，最近的研究表明目前的12個月之間的戰鬥之旅“是不足夠的時間”為兵“重置” ，並收回由應力是一個戰鬥旅抽穗前回到戰爭。

Colonel Joseph Horam says antidepressants have made “a striking difference” in the way troops are treated in war.上校約瑟夫霍拉姆說，抗抑鬱藥已取得了“驚人的差異： ”在部隊的方式處理在戰爭中。 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.一名醫生，在懷俄明州的陸軍國民警衛隊，霍拉姆服務在沙特阿拉伯的第一次海灣戰爭期間，並已部署到伊拉克的兩倍，在這場戰爭中。 “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. ： “在波斯灣戰爭，我們沒有這些藥物，所以我們的基本宗旨是'三hots和搖籃” -讓強調，部隊一點休息和放鬆，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. “如果他們沒有得到更好的權利以外，他們要需要頭後方可能走出劇場” ，但在他最近不惜在巴格達在2006年，他對待一名士兵誰森嚴的伊拉克戰俘。 “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，雖然他有高層次的互動與被拘留後，情緒對抗，與他們-和攜帶武器， ”霍拉姆說。 “But he was part of a highly trained team, and we didn’t want to lose him. “但他的一個組成部分，受過高度訓練的球隊，我們不想失去他。 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，我們把他一ssri ，並在一個星期內，他是一個全新的人了，我們回到了他的全部責任“ 。

It wasn’t until November 2006 that the Pentagon set a uniform policy for all the services.但直到2006年11月說，五角大樓成立一個統一的政策，所有的服務。 But the curious thing about it was that it didn’t mention the new antidepressants.但奇怪的事情，這是它並沒有提到新的抗抑鬱藥。 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，它只是禁止從部隊採取較舊的毒品，包括“鋰，抗驚厥藥和抗精神病藥物。 ”我們的目標，一位與會者在制定政策說，這是給ssris了“綠燈”沒有這樣說。 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，公佈三名軍事精神科醫生在軍事醫學 ，獨立的Journal of the協會軍事外科醫生的美國，敦促軍事醫生為首的為阿富汗和伊拉克“的要求，相當數量的ssri他們是最舒服的處方“ ”治療新發病的抑鬱症“ ，一旦在戰爭中區。 The medications, the doctors concluded, help “to ‘conserve the fighting strength,’” the motto of the Army Medical Corps.藥物，醫生的結論是，幫助“ '保存戰力， ”為口號，軍隊醫療團。

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.這些天瑞奇-現在的一名上校和精神科顧問，軍隊外科醫生一般-認為，軍隊的使用ss ris幫助de stigmatize精神問題。 “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. “我們正在試圖做的是使治療抑鬱症和創傷後應激障礙-尤其是創傷後應激障礙，這是相當普遍的士兵現在-相當例行的， ”她說。 “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. “我們不希望把它更難的鄉親做他們的工作和他們的使命說，他們無法使用這些藥物。 ”瑞奇，誰溝通“的6倍，每天”與她的同事們在戰爭中區，說，她不知道“任何壞的結果”所造成的士兵採取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.威廉溫肯韋爾德小，誰發出的2006年的政策，作為五角大樓的頂端醫生之前下台，去年說，新的藥物，運作良好。 “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. “作戰提出了一些獨特而重要的變數-顯然，那些誰正在接受治療的獲得槍支，他們可能受到重大壓力，所以他們必須非常仔細地評估，和良好的臨床決定需要作出的， ”溫肯韋爾德告訴時間。 “It’s my belief that is happening.” “這是我的信念正在發生的事情” 。

“In a Total Daze” “在一個總澤”
And yet the battlefield seems an imperfect environment for widespread prescription of these medicines.然而，戰場上似乎是一個不完美的環境，廣泛的處方這些藥物。 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 ，誰花了15個月，在伊拉克前回家，在2004年5月，說，許多更需要幫助的部隊-藥劑或以其他方式-但不得到它，因為擔心它會傷害他們的機會晉升。 “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. “他們不想破壞他們的職業或讓大家去在一個車隊，以拿起你的藥方，說： ” lejeune ，現在34和住在猶他州。 “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，當你有一個問題，你去看醫生，和你有治療的跟進，一些藥物治療。 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，你看醫生，只有一次或兩次，但你繼續得到藥物而不斷“ 。 lejeune說，藥物-結合戰爭的其他壓力-創造不適宜士兵。 “There were more than a few convoys going out in a total daze.” “有更多的比數車隊走出去，在共澤” 。

About a third of soldiers in Afghanistan and Iraq say they can’t see a mental-health professional when they need to.大約三分之一的士兵在阿富汗和伊拉克說，他們不能看到一個心理健康的專業，當他們需要。 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.當數量的部隊在伊拉克的激增3.0萬，去年有多少軍隊心理健康的工人仍然是相同的-約2 00名-決策輔導和照顧，甚至更嚴厲的獲得。

“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. “倦怠和同情疲勞症”不斷上升，這些人員，並有“最近精神科後送”軍隊心理衛生工作者從伊拉克撤軍， 2007年的調查說。 Soldiers are often stationed at outposts so isolated that follow-up visits with counselors are difficult.士兵往往是駐紮在前哨，使孤立的後續訪問與輔導員是困難。 “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.” “在一個完美的世界， ”納什承認，誰剛剛退休的來自海軍， “你不會要依賴於藥物作為您的第一線治療，但在部署的設置，往往是你有所有” 。

And just as more troops are taking these drugs, there are new doubts about the drugs’ effectiveness.正如更多的部隊正在這些藥物，有新的疑慮，有關藥物的有效性。 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.一對最近的報告由蘭德公司和聯邦醫學研究院（移徙組織）提出質疑，只是多少新藥物可以做，以減輕創傷後應激障礙。 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.”蘭德研究，發表在4月表示， “整體的效果， ssris ，即使在最大的臨床試驗，是溫和的” 。去年10月，國際移民組織的結論， “證據不足，以確定療效ssris在治療創傷後應激障礙。 “

Chris LeJeune could have told them that.克里斯lejeune可以告訴他們。 When he returned home in May 2004, he remained on clonazepam and other drugs.當他回國以後，在2004年5月，他仍然對氯硝西泮與其他藥物。 He became one of 300,000 Americans who served in Iraq and Afghanistan and suffer from PTSD or depression.他成為一個美國人300000誰曾任職於伊拉克和阿富汗遭受創傷後應激障礙或抑鬱症。 “But PTSD isn’t fixed by taking pills — it’s just numbed,” he claims now. “創傷後應激障礙，但並不固定以藥丸-這只是麻木，他聲稱： ”現在。 “And I felt like I was drugged all the time.” So a year ago, he simply stopped taking them. “我覺得自己被麻醉的所有時間。 ”因此，一年前，他乾脆停止服用。 “I just started trying to fight my demons myself,” he says, with help from VA counseling. “我剛開始試圖撲滅我的魔自己， ”他說，幫助VA部輔導。 He laughs when asked how he’s doing.他笑說，當記者問他如何做。 “I’d like to think,” he says, “that I’m really damn close back to normal.” “我想認為， ”他說， “我真的可惡接近恢復正常” 。

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