Darker side of “wonder drugs”

When Charles Medawar, a professional consumer advocate in the UK specialising in medicines policy and drug safety issues, first made The antidepressant web available on his Social audit website in 1998, the kinds of concerns he was expressing about antidepressants were very much on the fringe. In 2004, with the publication of Medicines out of control?, the mainstream has moved significantly towards Medawar’s stance.

Together with Ralph Nader, Medawar began his career as a consumer advocate in the United States some 30 years ago, and experience has taught him the need for persistence and assertiveness in challenging the prevailing view in psychiatry. Recent scientific publications have largely vindicated his claims that the newer antidepressant drugs cause dependence and suicidal behaviour, and have poor efficacy; that the pharmaceutical industry is in the business of disease promotion; and that much “expert opinion” is compromised.

He and his coauthor, Anita Hardon, an anthropologist, begin with a historical overview of psychotropic medications. They describe a recurrent pattern of new “wonder drugs” first hailed as the answer to mental illness, or to addiction, and eventually discarded as ineffectual, habit-forming, or frankly dangerous. The focus then shifts to the newer antidepressants, and the authors discuss the problems of patients who become dependent on the medication; the manipulation by the pharmaceutical industry of the public perception of the need for antidepressants; and the way in which regulatory authorities have failed public health.

Medawar was instrumental in drawing attention to the real and significant adverse effects of these newer antidepressants, paroxetine in particular, and for this he deserves praise. One quibble is that he does not always show the same level of healthy scepticism to some of the reports of the apparent side effects of these drugs as he does to their apparent benefits — their capacity to be a “nocebo” does not get as much attention as their placebo qualities.

Jon N JureidiniHead, Department of Psychological Medicine Women’s and Children’s Hospital, Adelaide, SA