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Antidepressants and the risks of untreated illnesses

21 Montagu Square, London W1H 1RE

Sir : As always, David Healy provides a stimulating point of view in his survey of the fashions of 20th century psychiatry (Psychiatric Bulletin, January 2000, 24, 1-3). But when it comes to antidepressants, a critical viewpoint seems to have been abandoned for anecdotal smears.

We are told that "the complete transformation of personality... was becoming the goal". Who's goal ? Where is the evidence that any scientist or any company has had this as an objective ? David Healy said that it was "most clearly articulated" in Kramer's (1993) Listening to Prozac. But as a scientist, he surely cannot authenticate that worthless collection of clinical anecdotes, combined as it was with a naive misconstruction of the role of serotonin. Interestingly, none since Kramer has claimed similar achievements.

More seriously, David Healy reports an American high school massacre, where there were "suggestions that one of the teenagers had an antidepressant in their (sic) blood stream". Were these suggestions true ? If so, which antidepressant was involved and were any other drugs present ? Was the other teenagar drugfree ? If so, what difference did the unidentified antidepressant make ? And what about the numerous other incidents of this kind in recent years ?

Healy considers none of these critical questions, but quotes without comment a statement by the American Psychiatric Association President which emphasised the dangers of untreated mental illness. So far as one can make out, we are supposed to feel contempt for this statement, all because of `suggestions' as to what might have happened at a particular school. Does he believe there are no risks from untreated mental illness ?

If David Healy wants to argue a case, he should do so on the basis of facts, rather than suggestive smears and half-truths.

References

KRAMER, P. (1993) Listening to Prozac. New York : Viking Press.

Author's reply

North Wales Department of Psychological Medicine, Hergest Unit, Ysbyty Gwynedd, Bangor, Gwynedd LL57 2PW

Sir : As an editor, Hugh Freeman will appreciate that covering a century's sweep risks giving hostages to fortune on specific details. I focused on how therapy establishments have a habit of blaming the disease and not the treatment. Professor Freeman does not disagree that this is what the psychoanalytical establishment did. An article in the Psychiatric Bulletin in 1981 predicted a similar dynamic would develop within biological psychiatry. My contention is that it has. Whether Eli Lilly were the first to formulate'a blame the disease not the drug' defence for therapeutic failure is not established, but I have documented in detail that this did happen (Healy, 2000).

In the Colorado shootings, the lead teenager was taking fluvoxamine. The emotional indifference that selective seretonin reuptake inhibitors (SSRIs) can cause may have contributed to this tragedy. I do not claim that it did so, but the response of the American Psychiatric Association to deny the possibility is based on neither research nor decency.

As regards perceptions that SSRI use is being aimed at personality transformation rather than simply the treatment of disease, there is a recent series of articles on this issue (Elliott et al, 2000). There is also growing concern that many preschool children in America and Britain are receiving SSRIs (Zito et al, 2000). What disease is being treated here ?

References

ELLIOTT, C., KRAMER, P., HEALY, D., et al(2000) Prozac, alienation and the self. Hastings Center Report, 30, 7-40.

HEALY, D. (2000) Guest editorial. A failure to warn. International Journal of Risk and Safety in Medicine, in press.

ZITO, J. M., SAFER, D. J., DOSREIS, S., et al(2000) Trends in the prescribing of psychotropic medications to pre-schoolers. Journal of the American Medical Association, 283, 1025-1030.[Abstract/Free Full Text]

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