"Antidepressants should be available on request - even if you aren't ill"

This was the headline of a press release just issued by the Royal Society of Medicine, a fanfare to a paper published in the November issue of its journal (Charlton, 1998). The gist is this:

"Dr Bruce Charlton … argues that doctors should be prescribing some psychiatric drugs at the patient's request - even when the patient does not have symptoms of depression.

"Evidence from recent trials now suggests that even healthy people can fundamentally benefit from taking antidepressants like Seroxat (the so-called 'shyness drug'), and Prozac. Those taking these drugs say they feel more comfortable in social situations, and have lower levels of unpleasant emotions, like anger or frustration.

"'Lifestyle' drugs given out on request are nothing new, Dr Charlton points out. The contraceptive pill has been available for thirty years on the principle that, as long as there is no significant danger from side-effects, doctors should prescribe it to anyone who asks for it.

"Why do we need these drugs at all? Arguably modern life is not a 'natural environment' for humans. We live in a world that is changing too fast for evolution to catch up - but there are new ways to make the best of the situation.. …

"In the end, Dr Charlton argues, we are living in an artificial world and we cannot avoid artificial ways of coping with it. If humans are to be happy in a modern society, many will need artificial help. And if drugs such as tea, coffee, aspirin and alcohol are an accepted part of everyday life - why not antidepressants?"

The author, a lecturer at Newcastle University, was accordingly interviewed (12 November) on a BBC Radio 4 programme, You & Yours. He appeared to have little understanding of antidepressant benefits and risks, and seemed surprised to learn they could cause withdrawal symptoms. The interviewer, John Waite, put him right.

Another expert on the programme was Dr Cosmo Hallstrom, Professor of Psychiatry at Charing Cross Hospital, London. His major contribution was to illustrate the confusion there is over definition: "Can I just jump back a little bit, to say that I don't believe antidepressants are addictive: they may cause dependence, they may cause withdrawal symptoms, but they're not addictive… so they're not that addictive." This is the first time I've heard it said, at this level, that antidepressants "may cause dependence". Alas it was not said with convinction and may only have been a telling slip of the tongue.

Pam Armstrong (CITA, 1998) was the one guest on the programme who did know what she was talking about, but it would be flaunting bias to say more. 

B G Charlton, Psychopharmacology and the human condition, J. Roy Soc Med, 91, November 1998, 599-601.

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