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Reviews Book

Medicines out of Control? Antidepressants and the Conspiracy of Goodwill

BMJ 2004; 329 doi: (Published 02 December 2004) Cite this as: BMJ 2004;329:1350
  1. Sean A Spence (, reader in psychiatry
  1. University of Sheffield

    The treatment of depression has seldom been more controversial. The safety of new antidepressants is subject to radical reappraisal, while an unpleasant question looms: can we really trust scientific evidence? Medawar and Hardon give a detailed analysis of this quagmire, massively annotated with footnotes and verbatim quotations.

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    Charles Medawar, Anita Hardon

    Aksant, £19.25/€27.50/$34.50, pp 260 ISBN 90 5260 134 8

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    It is understandable that the references sometimes get lost or the argument wanders, for the problem is not focal but pervasive. Theirs is an indictment of “big pharma” (the drug industry), doctors (both as prescribers and researchers), the regulatory authorities, politicians, and, ultimately, the values of society itself. Building on the evidence that earlier treatments of “distress” (such as opium, barbiturates, and benzodiazepines) initially seemed benign, only to wreak havoc later, the authors locate a similar optimism among early accounts of some antidepressants (particularly the selective serotonin reuptake inhibitors or SSRIs).

    However, they suggest that there is something different about the current debate—something that is about precision, semantics, or sleight of hand, depending on your viewpoint. The authors argue …

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