The so-called psychopharmaceutical revolution began in the 1950s, with apparently ever better drugs coming to market. Amitriptyline (Elavil), introduced in 1961, was one of the first ‘antidepressants’. Over the next decades, many other antidepressants came out, including fluoxetine (Prozac). In the 2000s, critiques that antidepressants were no better than placebos could not slow down a massive global rise of prescriptions. In 2018, a large meta-analysis of clinical trials argued that antidepressants were indeed better than placebos, but that none of the new drugs was as effective as the old amitriptyline. 1961 is also the birth year of psychiatry in the Himalayan country of Nepal. Since the 1960s, Nepali psychiatrists have been using amitriptyline as their first-line drug. The inclusion of amitriptyline in the first WHO list of Essential Drugs (1977) cemented its status. All the ‘new’ psychopharmaceuticals came to Nepal, but they never displaced the ‘old’ amitriptyline. No other drug could beat amitriptyline's affordability, availability, and efficacy for the typical Nepali depression patient: a ‘somatizer’ who suffers from multiple bodily aches, insomnia, and anxiety. Fieldwork with Nepali psychiatrists reveals the tenacity of local affordances over global changes in evidence and health policy.

所谓的心理药物革命始于1950年代，显然有更好的药物投放市场。于1961年推出的阿米替林（Elavil）是最早的“抗抑郁药”之一。在接下来的几十年中，出现了许多其他抗抑郁药，包括氟西汀（Prozac）。在2000年代，批评抗抑郁药并不比安慰剂好，这并不能减缓全球处方药的大量兴起。2018年，一项大型的临床试验荟萃分析认为，抗抑郁药的确比安慰剂好，但新药均不如老阿米替林有效。1961年也是尼泊尔喜马拉雅国家精神病学的诞生年。自1960年代以来，尼泊尔的精神科医生一直使用阿米替林作为一线药物。将阿米替林列入第一个WHO清单《基本药物》（Essential Drugs，1977）巩固了它的地位。所有“新”精神药物都来到尼泊尔，但他们从未取代过“老”阿米替林。对于典型的尼泊尔抑郁症患者，没有其他药物可以击败阿米替林的可负担性，可得性和功效：患有多种身体疼痛，失眠和焦虑症的“躯体化剂”。与尼泊尔精神科医生的实地调查揭示了当地对全球证据和卫生政策变化的承受能力。