草根影響力新視野 琪拉編譯
當溫蒂杜蘭女士與她的先生史都華杜蘭共進最後一次晚餐時，史都華煩躁到一直抖腳，無法停止。才剛吃完抗憂鬱藥物的他也不瞭解怎麼了。隔天，史都華這位57歲的律師，走到火車月台，就在火車來時，跳下月台臥軌自殺了。
（照片摘自：https://www.nytimes.com/2017/09/11/well/mind/paxil-antidepressants-suicide.html?rref=collection%2Fsectioncollection%2Fwell&action=click&contentCollection=well®ion=rank&module=package&version=highlights&contentPlacement=6&pgtype=sectionfront ）
杜蘭女士認為是她先生服用的抗憂鬱藥物帕羅斯汀(parazetine)造成的[靜坐不止]的副作用的影響，患者會嚴重到覺得自己要從皮膚裡面跳出來，痛苦到會想要自殺。溫蒂於是控告製藥商葛蘭素史克，控告它們未告知患者用藥的副作用。今年四月，法院判決杜蘭女士美金300萬元的損害賠償金。
圖為抗憂鬱藥物帕羅斯汀(parazetine)
儘管精神科學家相信抗憂鬱藥物的優點多過缺點，即便對年輕患者而言，藥物的有效性還是比風險性還高，但是很多專家認為大家還是太過輕忽藥物的危險性，誤導大家可以輕鬆服藥卻不需要注意風險。
心理醫師克拉瑪說他會提醒服抗憂鬱藥物的病患，如果服藥第一個禮拜有任何異常，像是焦慮、煩躁、恐慌、或是無法靜坐，就要停止，尤其是這些異常是突然發生的，而不是患者原本的憂鬱症狀。
靜坐不止(Akathisia)是抗憂鬱藥物的常見副作用。患者的症狀是焦慮、煩躁、無法安靜坐下、會一直前後走動，或是搖晃身體。但是靜坐不止的症狀因為患者原本的病症差不多，加深了醫師辨別的難度，甚至可能會以為是原本藥物的劑量不夠而加大劑量，反而造成患者的副作用更強烈。
曾經就有位45歲的男性因為服用抗憂鬱藥，導致靜坐不止，被醫師誤認為是恐慌症發作，而加大原本的藥物劑量，結果最後他自殺了。醫師因而警告大眾說[靜坐不止]可能是臨床上最難診斷的病症。
曾經就有位45歲的男性因為服用抗憂鬱藥，導致靜坐不止，被醫師誤認為是恐慌症發作，而加大原本的藥物劑量，結果最後他自殺了。醫師因而警告大眾說[靜坐不止]可能是臨床上最難診斷的病症。
在杜蘭女士的案子中，有物理治療師作證說杜蘭先生自殺的前一天，曾經來找過他看診，但是他因為太焦躁了，他無法讓自己安靜坐下，總是在椅子上騷動不安，物理治療師最後催促他隔天去找醫師回診，可惜杜蘭先生最後無法成行。
杜蘭女士認為要不是帕羅斯汀，她先生不會自殺。她並相信結婚36年的他們，原本擁有最好的歲月。她說:[我先生是成功的律師，因為工作壓力，他的確偶爾會焦慮和擔憂，但他總能克服與面對，他也會尋求諮商建議。]
她說:[我們唯一做錯的事就是服用帕羅斯汀。]
新聞 來源：
https://times.hinet.net/news/20696835
參考資料:
（以下為原文翻譯）
Lawsuit Over a Suicide Points to a Risk of
Antidepressants
一個自殺訴訟指出了抗憂鬱藥物的風險
Wendy Dolin’s husband, Stewart, killed himself in 2010, and she believes the antidepressant he had begun taking, a generic form of Paxil, was responsible. In April, a jury awarded her $3 million. Whitten Sabbatini for The New York Times
溫蒂多林的丈夫—斯圖爾特於2010年自殺了。她認為他所服用的抗憂鬱劑—克憂果（Paxil)的學名藥，要負起這個責任。在四月份，陪審團判賠給她300萬美元。 “紐約時報”的巴巴蒂尼報導。(譯者按：學名藥為非原專利藥廠所生產的同樣成份藥物)
The last dinner Wendy Dolin had with her husband, Stewart, he was so agitated that he was jiggling his leg under the table and could barely sit still. He had recently started a new antidepressant but still felt very anxious. “I don’t get it, Wen,” he said.
溫蒂多林和他的先生斯圖爾特最後一次吃晚餐時，他非常地焦慮，以至於他的腿在桌子下動不停，並且幾乎無法安靜坐著。 他最近開始服食一種新的抗憂鬱劑，但仍然感到非常焦慮。他說：「我不瞭解耶，溫蒂」
The next day, Mr. Dolin, a 57-year-old Chicago lawyer, paced up and down a train platform for several minutes and then threw himself in front of an oncoming train.
第二天，這位五十七歲的芝加哥律師，多林先生在火車平台上來回走了幾分鐘，然後在迎面而來的火車前面跳了下去。
Ms. Dolin soon became convinced that the drug her husband had started taking five days before his death — paroxetine, the generic form of Paxil — played a role in his suicide by triggering a side effect called akathisia, a state of acute physical and psychological agitation. Sufferers have described feeling as if they were “jumping out of their skin.”
多林太太很快就確信，她丈夫死亡前已經服用五天的藥物，克憂果(Paxil)的學名藥，在他的自殺中發揮了作用，引發了一種稱為靜坐不能(akathisia)的副作用，它是一種急性的身心激動的狀態。據受害者描述，這種感覺就好像他們要『跳出皮膚』。
The distress of akathisia may explain the heightened risk of suicide in some patients, some psychiatrists believe. The symptoms are so distressing, a drug company scientist wrote in the Journal of Psychopharmacology, that patients may feel “death is a welcome result.”
某些精神科醫師認為，靜坐不能的苦可以解釋在某些患者身上增加的自殺機率。藥物公司的科學家在精神藥理學雜誌上寫道，症狀是如此的令人沮喪，以致使患者可能會感覺到『死亡是一個受歡迎的結果』。
Ms. Dolin sued the original manufacturer of Paxil, GlaxoSmithKline, claiming the company had not sufficiently warned of the risks associated with the drug. In April, a jury awarded Ms. Dolin $3 million in damages.
多林女士起訴了克憂果(Paxil)的原始製造商葛蘭素史克公司，聲稱該公司沒有充分警告與該藥物相關的風險。在四月份，陪審團判決多林女士獲得損害賠償300萬美元。
The case is a rare instance in which a lawsuit over a suicide involving antidepressants actually went to trial; many such cases are either dismissed or settled out of court, said Brent Wisner, of the law firm Baum Hedlund Aristei Goldman, which represented Ms. Dolin.
本案是涉及抗憂鬱藥物的自殺訴訟中罕見的案例，它真的進入法院審判的過程。代表多林女的Baum Hedlund Aristei Goldman (位於加利福尼亞州洛杉磯的律師事務所)律師事務所的布倫特·威斯納(Brent Wisner)說，很多這樣的案子都在法院之外被駁回或解決了。
The verdict is also unusual because Glaxo, which has asked the court to overturn the verdict or to grant a new trial, no longer sells Paxil in the United States and did not manufacture the generic form of the medication Mr. Dolin was taking. The company argues that it should not be held liable for a pill it did not make.
這種判決也是不尋常的。因為葛蘭素史克公司已經不在美國銷售克憂果(Paxil)，並且不製造多林先生正在服用的學名藥，因此要求法院推翻該裁決或批准新的審判。該公司認為不應對他們沒有製造的藥片負責。
Concerns about safety have long dogged antidepressants, though many doctors and patients consider the medications lifesavers.
對安全性的擔心長期困擾著抗憂鬱劑，儘管許多醫生和患者認為這些藥物就像救生員一樣。
Ever since they were linked to an increase in suicidal behaviors in young people more than a decade ago, all antidepressants, including Paxil, have carried a “black box” warning label, reviewed and approved by the Food and Drug Administration, saying that they increase the risk of suicidal thinking and behavior in children, teens and young adults under age 25.
自從十多年前青少年自殺行為的增加與抗憂鬱劑有關聯以來，食品藥品管理局審查並批准所有這些藥物(包括Paxil)貼上黑框警示標語，說明它們增加25歲以下的兒童、青少年以及青年自殺想法和行為的風險。
The warning labels also stipulate that the suicide risk has not been seen in short-term studies in anyone over age 24, but urges close monitoring of all patients initiating drug treatment.
警告標語還說明，24歲以上任何人的短期研究中沒有看到自殺風險，但力促對所有開始藥物治療的患者進行密切監測。
Wendy and Stewart Dolin on vacation in Aspen, Colo., in 2006. Ms. Dolin’s lawsuit raised questions about the risk of suicide in adults taking antidepressants
溫蒂和斯圖爾特多林於2006年在科羅拉多州阿斯彭度假。多林女士的訴訟引起了有關成年人服用抗憂鬱藥物自殺風險的問題。
“The scientific evidence does not establish that paroxetine causes suicide, suicide attempts, self-harm or suicidal thinking in adult populations,” Frances DeFranco, a company spokeswoman, said in an email. “Any suicide is a tragedy, and a reminder that depression and other mental illnesses can be fatal.”
公司發言人弗朗西斯·德法蘭科（Frances DeFranco）在一封電子郵件中說：「科學證據沒有顯示帕羅西汀(paroxetine)可以在成年人中引起自殺，自殺企圖，自殘或是自殺思維。」「任何自殺都是悲劇，並提醒人們憂鬱症和其他精神疾病都可能是致命的。」
一個自殺訴訟指出了抗憂鬱藥物的風險
Wendy Dolin’s husband, Stewart, killed himself in 2010, and she believes the antidepressant he had begun taking, a generic form of Paxil, was responsible. In April, a jury awarded her $3 million. Whitten Sabbatini for The New York Times
溫蒂多林的丈夫—斯圖爾特於2010年自殺了。她認為他所服用的抗憂鬱劑—克憂果（Paxil)的學名藥，要負起這個責任。在四月份，陪審團判賠給她300萬美元。 “紐約時報”的巴巴蒂尼報導。(譯者按：學名藥為非原專利藥廠所生產的同樣成份藥物)
The last dinner Wendy Dolin had with her husband, Stewart, he was so agitated that he was jiggling his leg under the table and could barely sit still. He had recently started a new antidepressant but still felt very anxious. “I don’t get it, Wen,” he said.
溫蒂多林和他的先生斯圖爾特最後一次吃晚餐時，他非常地焦慮，以至於他的腿在桌子下動不停，並且幾乎無法安靜坐著。 他最近開始服食一種新的抗憂鬱劑，但仍然感到非常焦慮。他說：「我不瞭解耶，溫蒂」
The next day, Mr. Dolin, a 57-year-old Chicago lawyer, paced up and down a train platform for several minutes and then threw himself in front of an oncoming train.
第二天，這位五十七歲的芝加哥律師，多林先生在火車平台上來回走了幾分鐘，然後在迎面而來的火車前面跳了下去。
Ms. Dolin soon became convinced that the drug her husband had started taking five days before his death — paroxetine, the generic form of Paxil — played a role in his suicide by triggering a side effect called akathisia, a state of acute physical and psychological agitation. Sufferers have described feeling as if they were “jumping out of their skin.”
多林太太很快就確信，她丈夫死亡前已經服用五天的藥物，克憂果(Paxil)的學名藥，在他的自殺中發揮了作用，引發了一種稱為靜坐不能(akathisia)的副作用，它是一種急性的身心激動的狀態。據受害者描述，這種感覺就好像他們要『跳出皮膚』。
The distress of akathisia may explain the heightened risk of suicide in some patients, some psychiatrists believe. The symptoms are so distressing, a drug company scientist wrote in the Journal of Psychopharmacology, that patients may feel “death is a welcome result.”
某些精神科醫師認為，靜坐不能的苦可以解釋在某些患者身上增加的自殺機率。藥物公司的科學家在精神藥理學雜誌上寫道，症狀是如此的令人沮喪，以致使患者可能會感覺到『死亡是一個受歡迎的結果』。
Ms. Dolin sued the original manufacturer of Paxil, GlaxoSmithKline, claiming the company had not sufficiently warned of the risks associated with the drug. In April, a jury awarded Ms. Dolin $3 million in damages.
多林女士起訴了克憂果(Paxil)的原始製造商葛蘭素史克公司，聲稱該公司沒有充分警告與該藥物相關的風險。在四月份，陪審團判決多林女士獲得損害賠償300萬美元。
The case is a rare instance in which a lawsuit over a suicide involving antidepressants actually went to trial; many such cases are either dismissed or settled out of court, said Brent Wisner, of the law firm Baum Hedlund Aristei Goldman, which represented Ms. Dolin.
本案是涉及抗憂鬱藥物的自殺訴訟中罕見的案例，它真的進入法院審判的過程。代表多林女的Baum Hedlund Aristei Goldman (位於加利福尼亞州洛杉磯的律師事務所)律師事務所的布倫特·威斯納(Brent Wisner)說，很多這樣的案子都在法院之外被駁回或解決了。
The verdict is also unusual because Glaxo, which has asked the court to overturn the verdict or to grant a new trial, no longer sells Paxil in the United States and did not manufacture the generic form of the medication Mr. Dolin was taking. The company argues that it should not be held liable for a pill it did not make.
這種判決也是不尋常的。因為葛蘭素史克公司已經不在美國銷售克憂果(Paxil)，並且不製造多林先生正在服用的學名藥，因此要求法院推翻該裁決或批准新的審判。該公司認為不應對他們沒有製造的藥片負責。
Concerns about safety have long dogged antidepressants, though many doctors and patients consider the medications lifesavers.
對安全性的擔心長期困擾著抗憂鬱劑，儘管許多醫生和患者認為這些藥物就像救生員一樣。
Ever since they were linked to an increase in suicidal behaviors in young people more than a decade ago, all antidepressants, including Paxil, have carried a “black box” warning label, reviewed and approved by the Food and Drug Administration, saying that they increase the risk of suicidal thinking and behavior in children, teens and young adults under age 25.
自從十多年前青少年自殺行為的增加與抗憂鬱劑有關聯以來，食品藥品管理局審查並批准所有這些藥物(包括Paxil)貼上黑框警示標語，說明它們增加25歲以下的兒童、青少年以及青年自殺想法和行為的風險。
The warning labels also stipulate that the suicide risk has not been seen in short-term studies in anyone over age 24, but urges close monitoring of all patients initiating drug treatment.
警告標語還說明，24歲以上任何人的短期研究中沒有看到自殺風險，但力促對所有開始藥物治療的患者進行密切監測。
Wendy and Stewart Dolin on vacation in Aspen, Colo., in 2006. Ms. Dolin’s lawsuit raised questions about the risk of suicide in adults taking antidepressants
溫蒂和斯圖爾特多林於2006年在科羅拉多州阿斯彭度假。多林女士的訴訟引起了有關成年人服用抗憂鬱藥物自殺風險的問題。
“The scientific evidence does not establish that paroxetine causes suicide, suicide attempts, self-harm or suicidal thinking in adult populations,” Frances DeFranco, a company spokeswoman, said in an email. “Any suicide is a tragedy, and a reminder that depression and other mental illnesses can be fatal.”
公司發言人弗朗西斯·德法蘭科（Frances DeFranco）在一封電子郵件中說：「科學證據沒有顯示帕羅西汀(paroxetine)可以在成年人中引起自殺，自殺企圖，自殘或是自殺思維。」「任何自殺都是悲劇，並提醒人們憂鬱症和其他精神疾病都可能是致命的。」
Ms. Dolin’s lawsuit, however, has lifted the curtain on data from early clinical trials of Paxil, renewing concerns that older adults, who use antidepressants in far greater numbers than young people, may also be at greater risk of self-harm when taking the drugs.
然而，多林女士的訴訟已經揭露了克憂果(Paxil)早期臨床試驗數據的帷幕，重新關注年齡高於年輕的人，更多的他們正在使用抗憂鬱劑，同時也可能面臨自我傷害的更大風險。
The documents indicate that several suicides and suicide attempts in early clinical trials that were attributed to patients on a placebo — and which made Paxil look safer by comparison — should not have been counted, and that an F.D.A. reviewer later told the company as much. Glaxo eventually reanalyzed its data, and in 2006 enhanced the warning on Paxil, cautioning that among adults of all ages with major depressive disorder, “the frequency of suicidal behavior was higher in patients treated with paroxetine compared with placebo” — 6.7 times higher.
文件顯示，在早期臨床試驗中，歸因吃安慰劑患者的幾次自殺和自殺企圖，不應該被計算在內，因為那使得克憂果(Paxil)比較起來是安全的，而且食品藥物管理局審查者後來是這樣告知這家公司。葛蘭素史克公司最終重新分析了其數據，並在2006年加強了對克憂果(Paxil)的警告，提醒所有年齡患有嚴重憂鬱的成年人中，『與安慰劑相比，帕羅西汀治療患者的自殺行為頻率更高』--為6.7倍。
But that label was replaced a year later, in June 2007, by the F.D.A.-mandated warning now carried on all antidepressants, which says only that the increased risk has been seenP among people under age 25.
但是一年後，2007年6月，該警告被食品藥物管理局強制性的警告所取代，所有抗憂鬱劑警告25歲以下的人才有增加自殺的風險。
A Delicate Risk Calculation
微妙的風險計算
Some 325 million prescriptions for antidepressants were filled last year in the United States, including 15 million for Paxil and paroxetine, according to IMS Health, a health care information company.
根據保健資訊公司 IMS Health 表示，美國去年開立了約3.25億份抗憂鬱藥的處方藥，其中包括1500萬的克憂果(Paxil)和帕羅西汀(paroxetine)。
But while one in 10 Americans aged 12 and older has filled an antidepressant prescription, one in seven adults aged 40 and over has done so, including nearly one in five middle-aged women, according to the National Center for Health Statistics.
據美國國家衛生統計中心報導，在美國人中，有十分之一的十二歲以上的青少年、七分之一的四十歲以上成年人，和包括將近五分之一的中年婦女已經服用抗憂鬱藥物。
Many psychiatrists say the benefits of antidepressants far outweigh the risks, even for younger patients, and that the drugs are highly effective and generally well tolerated. Several prominent experts have been critical of what they say is excessive attention to the dangers, which they say could potentially dissuade people who could benefit from treatment from accessing care.
許多精神科醫師認為抗憂鬱藥物的益處遠遠超過了風險，即使對於年輕患者來說，這些藥物是高度有效的並且普遍耐受性良好。幾位傑出的專家一直批評他們所謂的過於關注藥物的危險性，他們認為這可能會勸阻那些可以從治療中獲益的人。
The issue is complicated by the fact that depression and other mental illnesses can themselves lead to suicide.
這個問題會因為憂鬱症和其他精神疾病本身可能導致自殺，而變得複雜。
“Antidepressants prevent more suicides than they cause, probably by a large multiple,” said Dr. Peter Kramer, a psychiatrist and clinical professor emeritus at Brown University and the author of several books about antidepressants, including “Listening to Prozac.”
精神科醫師和布朗大學臨床榮譽教授，著作幾本關於抗憂鬱藥物的書，包括『傾聽百憂解』一書的作者彼得.克萊默( Peter Kramer )博士說：「抗憂鬱劑可以預防更多的自殺事件，可能甚至好幾倍的效果。」
Dr. Kramer, who was not involved in the Dolin litigation, said he urges patients to contact him right away if they have a bad reaction during the first weeks after starting treatment with the drugs — and especially in the first five days.
沒有參與多林訴訟的克萊默博士說，如果藥物開始治療後的頭幾週有不好的反應時，特別是在頭五天，他呼籲病人立即與他聯繫。
Suicide Data Incorrectly Reported in Drug Trials, Suit Claimed
訴訟宣稱在藥物試驗中的自殺數據不正確地被報導
Paxil was approved following large clinical trials. But two suicides recorded in the placebo group should not have been counted, an F.D.A. reviewer wrote. Read more »
一位食品藥物管理局的審查者寫道，在大量臨床試驗後克憂果(Paxil)獲得批准。但是在安慰劑組中記錄的兩次自殺不應該被計算在內。閱讀更多>>
“When I put people on medication for the first time, I say we’re going to be very cautious in the early going,” he said.
他說:「當我第一次讓人們服藥的時候，我們在一開始進行時將會很謹慎小心。」
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The prescribing information on antidepressants specifically warns that patients should be monitored for symptoms like anxiety, agitation, panic attacks, mania and akathisia. “There is concern that such symptoms may represent precursors to emerging suicidality,” the labels say, especially if they were “abrupt in onset” or “not part of the patient’s presenting symptoms.”
關於抗憂鬱劑的處方訊息特別提醒患者應監測焦慮，躁動，恐慌發作，躁狂症和靜坐不能等症狀。 「有人擔心這些症狀可能代表出現自殺的前兆，」標籤說，特別是如果它們「突然發作」或是「不是患者原本症狀的一部分」。
Akathisia is, by definition, a drug-induced syndrome. The word comes from Greek and means “not to sit,” referring to an inability to sit still. Akathisia is characterized by anxiety, restlessness and a compulsion to move or walk about; patients may pace back and forth, or fidget endlessly in their chairs
根據定義，靜坐不能(Akathisia)是藥物引發的一個症候群。這個字來自希臘語，意思是“不坐著”，指的是不能安靜坐著。靜坐不能的特徵是焦慮、不安和強迫性的移動或行走;患者可能會來回漫步，或者在椅子上無休止地扭動。
It may develop when a patient, adult or younger, begins treatment, but it can also emerge when the dosage of the drug is increased, decreased or discontinued. Patients who have tolerated a drug in the past may develop akathisia when they start a new course of treatment, experts say.
它可能出現於患者、成年人或年輕人開始治療時，也可能會伴隨藥物劑量的增加、減少或中斷時出現。專家說，患者在過去可以忍受的藥物，在新一輪的治療時可能會出現靜坐不能。
Akathisia is a fairly common and well-known side effect of antipsychotic medications, commonly used to treat disorders like schizophrenia but increasingly given for a variety of mental health complaints, including depression. But the association with antidepressants is not as well recognized, experts say, and incidence rates are hard to pin down.
靜坐不能是抗精神病藥物的常見和眾所周知的副作用，這些藥物通常用於治療精神分裂症等疾病，但是越來越常地用在各種心理症狀（包括憂鬱症）。專家說與抗憂鬱藥物的關聯性還沒有得到認可，並且發生的機率難以確定。
A group of psychopharmacologists who reviewed over 100 studies found the reported rate of what they broadly called “jitteriness/anxiety syndrome” — which they defined as a worsening of anxiety, agitation and irritability — ranged from 4 percent to 65 percent among patients initiating treatment with selective serotonin reuptake inhibitors, or S.S.R.I.s, the popular class of antidepressants to which Paxil belongs.
一批精神藥理學家回顧了超過100項研究發現，他們廣泛稱為『抖動/焦慮症候群』 (他們定義為焦慮，激動和煩躁的惡化)的通報率為4%到65%，在那些使用選擇性血清素回收抑製劑(S.S.R.I.)開始治療的病人身上。SSRI是克憂果(Paxil)所屬的抗憂鬱劑類型。
Psychiatrists linked S.S.R.I.-induced akathisia to suicidal behavior in a 1991 paper describing three patients who survived violent suicidal attempts — including jumping off the roofs of buildings and off a cliff — shortly after they had started fluoxetine or had the dose increased.
在1991年的一篇文獻中，描述了三名嘗試激烈自殺的患者，在開始使用氟西汀(fluoxetine)或劑量增加後不久，就跳下建築物屋頂和跳下懸崖。精神科醫生才將S.S.R.I.引起的靜坐不能與自殺行為關聯在一起。
The patients were removed from the drug, but then agreed to try another course of treatment with fluoxetine under close observation. All three became extremely agitated and had a recurrence of suicidal thoughts.
患者移除該藥物後，但他們隨後同意在密切觀察下嘗試另一療程使用氟西汀治療。所有這三個人都變成非常激動，並且再次出現自殺的想法。
“This is exactly what happened the last time I was on fluoxetine, and I feel like jumping off a cliff again,” one of the patients reportedly said. Another said she had tried to kill herself “because of these anxiety symptoms. It was not so much the depression.”
據報導其中有一名患者說:「這正是我上次使用氟西汀時發生的情況，而且我覺得想要再次跳下懸崖」。另一位說她試圖殺死自己:「是因為這些焦慮症狀。不是因為憂鬱。」
Dr. Anthony J. Rothschild, one of the study’s co-authors, has since disavowed the paper, saying it was an observation that has been disproved by subsequent drug company clinical trials. He testified as an expert witness for Glaxo in the Dolin trial.
研究共同作者之一的安東尼·羅斯柴爾德博士後來否定了這篇文章，說這只是一個觀察。而此文章在隨後的藥物公司臨床試驗時被駁斥。他在多林審判中成為葛蘭素史克公司的專家證人，出庭作證。
A photograph from the wedding of Wendy and Stewart Dolin in 1974. Mr. Dolin went on to a successful, if stressful, career as a high-powered attorney. Credit via Wendy Dolin
1974年溫蒂和斯圖爾多林的婚禮照片
多林先生後來成功地成為有權勢的律師，但是個有壓力的職業。
由溫蒂·多林提供
Akathisia symptoms so closely resemble symptoms of anxiety and depression that it may be hard for a doctor to distinguish between the underlying illness and what could be a side effect of the drug used to treat it, said Dr. Joanna Gedzior, an assistant clinical professor of psychiatry at the Fresno Medical Education Program of the University of California, San Francisco.
舊金山加州大學，弗雷斯諾醫學教育計劃的精神病學助理臨床教授葛茲爾(Joanna Gedzior) 博士說，靜坐不能的症狀非常類似於焦慮和憂鬱症的症狀，以致於醫生很難區分潛在的疾病和可能是用於治療的藥物的副作用。
If a doctor thinks the patient’s condition is deteriorating, he or she may increase the dose of the medication, which could be disastrous if the drug itself is causing the problem.
如果醫生認為患者的病情惡化，他或她可能會增加藥物的劑量，如果是藥物本身所引起的問題，這樣就可能成為災難。
“We have to be very careful about this and ask, ‘Is it something I’m giving the patient that’s causing this?’” said Dr. Gedzior, who wrote a paper on akathisia.
寫了一篇關於靜坐不能論文的葛茲爾(Gedzior)博士說:「我們必須非常小心這件事，並且問：『是我給病人的東西造成這種情況嗎？』」
Doctors at Southern Illinois University School of Medicine last year described the case of a 45-year-old man who developed akathisia just days after he was put on an antidepressant but was misdiagnosed as having panic attacks. When doctors doubled his dose, he attempted suicide.
去年南伊利諾大學醫學院的醫師們描述了一名45歲男子的案例，他服用抗憂鬱劑幾天後就發生了靜坐不能，但被誤診為恐慌發作。當醫生加倍劑量時，他試圖自殺。
The doctors warn that akathisia “can be one of the most ambiguous clinical diagnostic presentations in all of psychiatry” and is “often underdiagnosed or misdiagnosed.”
醫生警告說靜坐不能「可能是所有精神病學中最模糊的臨床診斷現象之一」，並且「經常被低估或誤診」。
“We know that anxiety and akathisia create a sense of hopelessness, especially if the feelings are not validated,” Dr. Gedzior said, and hopelessness can lead to suicidal thoughts. The combination of akathisia, anxiety and depression puts patients at risk of suicide, she believes.
葛茲爾(Gedzior)博士說：「我們知道焦慮和靜坐不能會產生絕望感，特別是如果這些感覺沒有得到認同」，那麼絕望就會導致自殺的想法。她相信靜坐不能、焦慮和憂鬱的組合使患者有自殺的風險。
Explaining to patients that their emotional turmoil may be caused by a drug side effect can alleviate their distress, she said. Doctors can reduce the patient’s discomfort by discontinuing the drug, or adding another prescription, such as an anti-anxiety medication.
她說:「跟患者解釋他們的情緒動盪可能是來自於藥物的副作用，可以減輕患者的痛苦。」醫生可以透過停用藥物，或者添加另一種處方藥如抗焦慮劑，來減輕患者的不適。」
During the Dolin trial, a therapist testified that Mr. Dolin had called to schedule a same-day session on July 14, the day before his suicide. But Mr. Dolin was unable to sit still during their meeting, shifted nervously in his chair, and could not calm down.
在多林訴訟案期間，一名心理治療師作證說，多林先生在他自殺的前一天7月14日打電話來要求當天治療。但多林先生在治療中不能安靜地坐著，在椅子上緊張地轉身並且無法冷靜下來。
The therapist was so worried that she called him at work the next day — the day of his suicide — to urge him to ask his doctor for anti-anxiety medication.
這名治療師非常地擔心，所以她在第二天（他自殺的那一天）打電話到他辦公室，並呼籲他去跟他的醫生要求抗焦慮藥物。
Ms. Dolin is convinced her husband was not suicidal until he developed akathisia as a side effect to paroxetine. Her husband was having “one of his best years ever,” she said. The couple were high school sweethearts who had been married for 36 years, and had adult children who were thriving and a large circle of friends.
多林女士相信她的丈夫不會自殺，直到他發展出帕羅西汀的副作用--靜坐不能。她說她的丈夫擁有『過去最好的一年』。他們是已經結婚36年的高中情侶，孩子已成年並蓬勃發展，他們也有一大群朋友。
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“Stewart occasionally had stress and anxiety associated with being a high-powered attorney, but he had great coping skills, and he would seek counseling and move on,” said Ms. Dolin, who has started an organization called Missd to raise awareness about the warning signs of akathisia.
多林太太說:「斯圖爾特身為有權勢的律師，偶爾也有壓力和焦慮，但是他有很好的應付能力，他會尋求心理諮商並繼續前進」，她已經成立了一個名為Missd的組織，以提高認識靜坐不能的警示徵兆。
“The only thing different this time was that he had started Paxil.”
「這次唯一不同的是他開始用了克憂果(Paxil)」
A version of this article appears in print on September 12, 2017, on Page D3 of the New York edition with the headline: A Suicide Leaves Tough Questions. Order Reprints| Today's Paper|Subscribe
這篇文章的一個版本於2017年9月12日在紐約版的第D3頁登出，標題為：一個自殺留下艱難的問題。訂購轉載|今日報紙|訂閱
由溫蒂·多林提供
Akathisia symptoms so closely resemble symptoms of anxiety and depression that it may be hard for a doctor to distinguish between the underlying illness and what could be a side effect of the drug used to treat it, said Dr. Joanna Gedzior, an assistant clinical professor of psychiatry at the Fresno Medical Education Program of the University of California, San Francisco.
舊金山加州大學，弗雷斯諾醫學教育計劃的精神病學助理臨床教授葛茲爾(Joanna Gedzior) 博士說，靜坐不能的症狀非常類似於焦慮和憂鬱症的症狀，以致於醫生很難區分潛在的疾病和可能是用於治療的藥物的副作用。
If a doctor thinks the patient’s condition is deteriorating, he or she may increase the dose of the medication, which could be disastrous if the drug itself is causing the problem.
如果醫生認為患者的病情惡化，他或她可能會增加藥物的劑量，如果是藥物本身所引起的問題，這樣就可能成為災難。
“We have to be very careful about this and ask, ‘Is it something I’m giving the patient that’s causing this?’” said Dr. Gedzior, who wrote a paper on akathisia.
寫了一篇關於靜坐不能論文的葛茲爾(Gedzior)博士說:「我們必須非常小心這件事，並且問：『是我給病人的東西造成這種情況嗎？』」
Doctors at Southern Illinois University School of Medicine last year described the case of a 45-year-old man who developed akathisia just days after he was put on an antidepressant but was misdiagnosed as having panic attacks. When doctors doubled his dose, he attempted suicide.
去年南伊利諾大學醫學院的醫師們描述了一名45歲男子的案例，他服用抗憂鬱劑幾天後就發生了靜坐不能，但被誤診為恐慌發作。當醫生加倍劑量時，他試圖自殺。
The doctors warn that akathisia “can be one of the most ambiguous clinical diagnostic presentations in all of psychiatry” and is “often underdiagnosed or misdiagnosed.”
醫生警告說靜坐不能「可能是所有精神病學中最模糊的臨床診斷現象之一」，並且「經常被低估或誤診」。
“We know that anxiety and akathisia create a sense of hopelessness, especially if the feelings are not validated,” Dr. Gedzior said, and hopelessness can lead to suicidal thoughts. The combination of akathisia, anxiety and depression puts patients at risk of suicide, she believes.
葛茲爾(Gedzior)博士說：「我們知道焦慮和靜坐不能會產生絕望感，特別是如果這些感覺沒有得到認同」，那麼絕望就會導致自殺的想法。她相信靜坐不能、焦慮和憂鬱的組合使患者有自殺的風險。
Explaining to patients that their emotional turmoil may be caused by a drug side effect can alleviate their distress, she said. Doctors can reduce the patient’s discomfort by discontinuing the drug, or adding another prescription, such as an anti-anxiety medication.
她說:「跟患者解釋他們的情緒動盪可能是來自於藥物的副作用，可以減輕患者的痛苦。」醫生可以透過停用藥物，或者添加另一種處方藥如抗焦慮劑，來減輕患者的不適。」
During the Dolin trial, a therapist testified that Mr. Dolin had called to schedule a same-day session on July 14, the day before his suicide. But Mr. Dolin was unable to sit still during their meeting, shifted nervously in his chair, and could not calm down.
在多林訴訟案期間，一名心理治療師作證說，多林先生在他自殺的前一天7月14日打電話來要求當天治療。但多林先生在治療中不能安靜地坐著，在椅子上緊張地轉身並且無法冷靜下來。
The therapist was so worried that she called him at work the next day — the day of his suicide — to urge him to ask his doctor for anti-anxiety medication.
這名治療師非常地擔心，所以她在第二天（他自殺的那一天）打電話到他辦公室，並呼籲他去跟他的醫生要求抗焦慮藥物。
Ms. Dolin is convinced her husband was not suicidal until he developed akathisia as a side effect to paroxetine. Her husband was having “one of his best years ever,” she said. The couple were high school sweethearts who had been married for 36 years, and had adult children who were thriving and a large circle of friends.
多林女士相信她的丈夫不會自殺，直到他發展出帕羅西汀的副作用--靜坐不能。她說她的丈夫擁有『過去最好的一年』。他們是已經結婚36年的高中情侶，孩子已成年並蓬勃發展，他們也有一大群朋友。
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“Stewart occasionally had stress and anxiety associated with being a high-powered attorney, but he had great coping skills, and he would seek counseling and move on,” said Ms. Dolin, who has started an organization called Missd to raise awareness about the warning signs of akathisia.
多林太太說:「斯圖爾特身為有權勢的律師，偶爾也有壓力和焦慮，但是他有很好的應付能力，他會尋求心理諮商並繼續前進」，她已經成立了一個名為Missd的組織，以提高認識靜坐不能的警示徵兆。
“The only thing different this time was that he had started Paxil.”
「這次唯一不同的是他開始用了克憂果(Paxil)」
A version of this article appears in print on September 12, 2017, on Page D3 of the New York edition with the headline: A Suicide Leaves Tough Questions. Order Reprints| Today's Paper|Subscribe
這篇文章的一個版本於2017年9月12日在紐約版的第D3頁登出，標題為：一個自殺留下艱難的問題。訂購轉載|今日報紙|訂閱
克憂果 TM 持續性藥效錠 12.5 毫克
SEROXATTM CR Tablets 12.5 mg (Paroxetine) （製藥商葛蘭素史克）
以下簡錄摘自 http://tw.gsk.com/media/716415/seroxat-cr-tablets-pi.pdf
【警語及注意事項】
服藥期間應嚴密監視患者之憂鬱症情形，以防其發生自殺行為。
在有重憂鬱疾患或是精神疾患之兒童或是青少年或青年人使用抗憂鬱藥會增加 其自殺的想法與行為。
在兒童與青少年之 SEROXAT 之臨床試驗，以 SEROXAT 治療病患比起安慰劑更易產生關於自殺傾向(自殺的傾向及自殺的想法)及敵意 (侵略性，反抗的行為與憤怒)的副作用。
(見不良反應)。缺乏關於兒童及青少年 的成長，熟成，
認知與行為的發展之長期安全性資料。
臨床上一般經驗指出，全部的抗憂鬱治療中，在復原的初期會增加自殺的風險。 以 SEROXAT 治療其他的精神症狀可能會增加自殺行為的風險，而這些精神症狀 可能也會伴隨有重憂鬱症⋯⋯
非精神科的醫生之協助及建議下，
都不應該停止服用任何精神科藥物。)
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