Re: Medicalising unhappiness: new classification of depression risks more patients being put on drug treatment from which they will not benefit
Over-prescription of antidepressants is certainly increasing, for indications where talking therapy is more appropriate, as in bereavement. This is not a new problem, and raises issues about how clinical trials are conducted. ‘The present process leading to registration of a psychotropic can take place without any comparison with non-pharmacological treatment options. This policy has to be questioned.’(1) However, antidepressants are also moving into other fields. A current example is the FOCUS trial (Fluoxetine or control under supervision) for stroke patients, with the hypothesis that fluoxetine (Prozac) might help with motor recovery. (2) The precedent for this is a small French trial, FLAME (3). In this study patients were excluded if they were already on an antidepressant, for obvious reasons. However, in FOCUS they are not, as long as the antidepressant is not in the same class as fluoxetine, i.e. an SSRI or an MAOI.
This raises serious concerns, not least of which is the difficulty of coping with two lots of antidepressant side effects for those randomized to the treatment arm. These are by no means negligible, and since patients may well be on other medications such as anticoagulants there may be further difficulties and contra-indications.
Even the environment suffers: Jean Sprackland notes that fluoxetine ‘has been leaking into oceans and rivers for years, but the extraordinarily steep rise in prescription means that levels are rocketing’. Apparently this ‘can spell disaster for the shrimps. It alters their perceptions, making them more reckless than usual, and more vulnerable to unaccustomed danger.’ (4)
Perhaps it’s time to reconsider. Even the shrimps might benefit.
1. Lilhja J, Larsson S, Hamilton D, Bauer M. Ethical Values in the treatment of Depression and Anxiety, in Pharmaceutical Ethics (Chichester: Wiley 2002), p. 156.
2. Fluoxetine Or Control Under Supervision (FOCUS) trial: to establish the effect(s) of routine administration of Fluoxetine in patients with a recent stroke: ISRCTN83290762.
3. Collet F, Tardy J, Albucher J-F et al. Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial. The Lancet Neurology 10 January 2011. DOI: 1016/51474-4422910)70314-8.
4. Sprackland J. Strands: a year of discoveries on the beach (London: Jonathan Cape 2012), p. 31.
Rapid Response:
Re: Medicalising unhappiness: new classification of depression risks more patients being put on drug treatment from which they will not benefit
Over-prescription of antidepressants is certainly increasing, for indications where talking therapy is more appropriate, as in bereavement. This is not a new problem, and raises issues about how clinical trials are conducted. ‘The present process leading to registration of a psychotropic can take place without any comparison with non-pharmacological treatment options. This policy has to be questioned.’(1) However, antidepressants are also moving into other fields. A current example is the FOCUS trial (Fluoxetine or control under supervision) for stroke patients, with the hypothesis that fluoxetine (Prozac) might help with motor recovery. (2) The precedent for this is a small French trial, FLAME (3). In this study patients were excluded if they were already on an antidepressant, for obvious reasons. However, in FOCUS they are not, as long as the antidepressant is not in the same class as fluoxetine, i.e. an SSRI or an MAOI.
This raises serious concerns, not least of which is the difficulty of coping with two lots of antidepressant side effects for those randomized to the treatment arm. These are by no means negligible, and since patients may well be on other medications such as anticoagulants there may be further difficulties and contra-indications.
Even the environment suffers: Jean Sprackland notes that fluoxetine ‘has been leaking into oceans and rivers for years, but the extraordinarily steep rise in prescription means that levels are rocketing’. Apparently this ‘can spell disaster for the shrimps. It alters their perceptions, making them more reckless than usual, and more vulnerable to unaccustomed danger.’ (4)
Perhaps it’s time to reconsider. Even the shrimps might benefit.
Heather Goodare
3 Glengyle Terrace
Edinburgh EH3 9LL
hm.goodare@virgin.net
1. Lilhja J, Larsson S, Hamilton D, Bauer M. Ethical Values in the treatment of Depression and Anxiety, in Pharmaceutical Ethics (Chichester: Wiley 2002), p. 156.
2. Fluoxetine Or Control Under Supervision (FOCUS) trial: to establish the effect(s) of routine administration of Fluoxetine in patients with a recent stroke: ISRCTN83290762.
3. Collet F, Tardy J, Albucher J-F et al. Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial. The Lancet Neurology 10 January 2011. DOI: 1016/51474-4422910)70314-8.
4. Sprackland J. Strands: a year of discoveries on the beach (London: Jonathan Cape 2012), p. 31.
Competing interests: No competing interests