Brain & Drugs
  • Mind Alteration By Prescription

    Prescription drugs have had medical and social uses since tincture of opium became popular. Cocaine use flourished in the US until it was outlawed in the second decade of the 20th century. Both opium and cocaine are natural drugs, plant derivatives used by native cultures and traded by European colonists to exploit the vulnerable. Barbiturates were next introduced and used as sedatives and sleeping pills until they were mostly replaced by new classes of tranquilizers.

    The manipulation of the modern psyche began in earnest in the 1950's with the growing use of "speed' for weight loss among housewives, barbiturate sleeping pills, and the introduction of Librium, the first modern tranquilizer. Housewives, actors and singers in the 50's and 60's were introduced to uppers and downers as tools of coping with the demands and disappointments of modern life. Most of the action centered around four drug classes: amphetamines, barbiturates, librium and alcohol. Citizens and celebrities died with alarming regularity from mixtures and overdoses of these drugs.

    Physicians who prescribed these chemical cocktails can be seen, in retrospect, as legal drug pushers for nice, middle and upper class patients. Doctors practices flourished on drug prescription, drug company profits were assured and, for a while at least, patients who survived seemed content with the mix of new and old drugs. The long-term results were not good, however, and problems of addiction, brain dysfunction (often called "nervous breakdowns" and "mental illness") accidents and suicide became increasingly prevalent. The combination of alcoholic beverages, uppers and downers produced chemical chaos in the brains of users, often with tragic results.

    Librium was replaced by a new class of drugs, the benzodiazepines. Valium was the best selling member of this class for many years until problems associated with its use became well known. Other Valium-like drugs were developed as tranquilizers and sleeping pills, to large extent, replacing barbiturates that were fatal in overdose. A common prescription for twenty capsules of secobarbital could kill. Valium as a sedative-tranquilizer has been replaced by related drugs with new names and no bad reputations but the same set of problems for the brain: some examples are Ativan, Xanax, Serax, Lorazepam and several sleeping pills such as Dalmane and Halcion.

    With the increases in recreational and illegal drug use in the 70's, social and political upheavals and a general disillusionment with the adverse effects of medical psychotropics, laws and attitudes began to change; not intelligently and not consistently, but irrationally. The medical and research use of LSD was halted; stricter controls on the prescription of amphetamines and barbiturates were instituted. These drug prohibition policies were opportunities for drug companies to make new, different drugs to fill the same market niches. Since then, a host of psychotropic drugs have been marketed and some of these newer drugs have proved to be very profitable.

    Antidepressants were a hard sell until recently. Although many drugs in this class modified the mood and behavior of patients, their slow action and many side effects were negative features. The introduction of a new class of antidepressants, led by Prozac changed the market for psychotropic drugs. The effects of Prozac on personality were widely publicized and drug companies advertise directly to the consumer, relegating physicians to the role of middleman. The patient now demands the prescription and the doctor complies. The claim is that Prozac can increase energy, confidence and assertiveness in people who are depressed. Shy people were added to list of potential customers. Although writers such as psychiatrist Peter Kramer (Listening to Prozac) suggested that the patient's interest in personality changing drugs was a new market force, nothing new really happened; it is the same old interest in psychotropic drugs but the names, the players and the prices changed. Cocaine still outsells Prozac, but the profitability of prescription antidepressant drugs has been outstanding.

    Depression has a useful social role; its main function is to reduce aggression and conflict. Prozac can facilitate the rage response and may lead to acts of aggression and violence that otherwise would not occur. Prozac also inhibits appetite for food and sexual appetites; sometime useful effects, but not always. In Canada, three antidepressants have been among the top-selling drugs; these are Prozac, Paxil, and Zoloft..

    Lauren Slater called Prozac the "big mac of medicine" because of its popularity and the faddish consumer appeal based on the futile hope that a drug could resolve human suffering. She described the dramatic and brief benefits of taking Prozac: "those first few mornings were fairy tales, tall tales, replete with all the bent beauty of a new world." Her story is not simple, however and the long-term effects of taking the drug are mixture of benefits and negative effects. An initial recovery from depression is not sustained and a three or four phase sequence can often be discerned, beginning with an initial improvement that occurs in the first 2 to 4 weeks. The statement the first time was the best time applies to most, if not to all psychotropic drugs.

    In Slater's experience, Prozac removed her sexual drive, blunted her creativity and reduced her appetite. The underlying problems are many and begin with the lack of specificity of the drug. Prozac blocks serotonin re-uptake and in stage 1 of its activity, probably increases serotonin receptor activity in all areas of the brain. Serotonin synapses are not all conveniently arranged just to alleviate depression and a whole complex of unrelated functions are affected. The brain is not passive and changes to offset or accommodate the drug activity; the effects then shift to an adapted state, different from the initial drug-dependent state. The person taking the drug has also shifted in terms of behavior and learning and may be coping with new problems such increased anger, loss of libido and blunted feelings.


    New problems created by the prescription chemicals may suddenly emerge such as unexpected bursts of anger and aggression or increased tendency to have violent suicidal thoughts. One young woman reported to me that after taking Prozac for two weeks, she had threatened her live-in boyfriend with hammer, chased him into the bathroom and attacked the closed door, smashing holes in the door until she more or less recovered composure. Her boyfriend fled the apartment and never returned. The boyfriend was domineering and verbally abusive, as boyfriends sometimes are, but the pre-Prozac young woman was compliant and never had a violent temper. Her Prozac rage is an example of chemically triggered behavior. Prozac may provoke agitated preoccupation with suicide or violence directed against others. The drug facilitates anger, as do most of the drugs that inhibit appetite.

    Martin Enserink reviewed the development of antidepressant drugs and stated: ˜antidepressants have evolved through several generations since the 1950s, each an improvement over its predecessor--or so advocates have claimed. but a government-sponsored study published last month confirmed what other analyses had shown before: the fashionable antidepressants of the 1990s are no more effective than those of previous generations. even the heavy-duty drugs of the Eisenhower era appear to be on a par with those used today. The study, a meta-analysis commissioned by the agency for health care policy and research (a part of the department of health and human services, US) and carried out by the evidence based practice center in San Antonio, Texas, looked at 315 studies carried out since 1980. it focused primarily on the hottest pills that have hit the market since 1987, the "selective serotonin reuptake inhibitors" , a group that includes such brands as prozac, paxil, and zoloft. The study found that on average, about 50% of patients in ssri treatment groups improved, compared to 32% in placebo groups. but in the more than 200 trials that compared new drugs with older ones, the two classes proved equally efficacious.

    "Because the newer drugs appear to have less severe side effects, however, patients may be able to stay on them longer. the failure to find evidence of progress is disappointing, scientists admit. and one of the biggest disappointments is that researchers still don't understand what causes--or relieves--depression. Most antidepressant drugs are based on the assumption that depression results from a shortage of serotonin or norepinephrine in the brain. Both are neurotransmitters, chemical messengers that cross the synapse, the cleft between two nerve cells. The first generation of antidepressants, discovered during the early 1950s, the MAO inhibitors, block monoamine oxidase, an enzyme that breaks down serotonin and norepinephrine. This allows the neurotransmitters to linger in the synapse, increasing their effect. Another type of drug discovered in the late 1950s, the tricyclics, prevents the nerve cells that release the neurotransmitters from mopping up these compounds shortly after they are released. Blocking "reuptake" also prolongs their effect. because studies pointed to serotonin shortage as the main culprit in depression, industry developed the selective reuptake inhibitors, which now dominate the market."

    The Chemical Soup

    Antidepressants are chemicals that are added to a dysfunctional chemical mix that caused dysfunction and dysphoria in the first place. few patients make any effort to alter their disease-causing lifestyle and few physicians make any effort to investigate and improve the patients chemistry overall. Drugs are added, mindlessly to the dysfunctional chemical mix and their effects merge with caffeine, alcohol, the chemistry of food additives, and contaminants, sugars, food allergy and airborne neurotoxins that act on the brain.

    Physicians have routinely prescribed drugs to patients who were sad, discouraged and thought of suicide. There is no evidence that antidepressant drugs prescribed have prevented suicide. For those of us who followed patients who were prescribed drugs by other physicians and who died of an overdose of those drugs, the prescriptions took on the ominous aspect of tools of self-destruction. the prescribing physician becomes an accomplice in the patients death, not a savior.

    Ill Advised, Harmful Prescriptions

    Antidepressants are increasingly prescribed to children and adolescents without good evidence of efficacy and safety. The US FDA issued a warning in 2003 regarding paroxetine (Paxil and Serotax) an antidepressant similar to Prozac. The results of 3 unpublished trials involving children with depression did not show benefit to taking paroxetine over placebo. In addition, suicidal thoughts, suicide attempts and episodes of self-harm were more frequent among the paroxetine users than among those in the placebo group. In another study involving children with social anxiety disorder, 2.4% of the 165 children given paroxetine had suicide-related adverse events as compared with none of 157 children given a placebo.

    Psychiatrist and ethicist, Colleen Clements, writes unusually insightful and brave commentary on medicine and psychiatry which I often find convincing. In an essay expressing concern about the first ever distribution of Prozac samples directly to the consumer in the USA she stated: "Medicine does tend to swing from therapeutic nihilism to therapeutic aggressiveness, and there are many times when that pendulum ethically should move to the side of medical aggressiveness. risk-taking is often the ethical choice. psychiatry, however, is an unsure discipline for medical aggressiveness. The science is not sufficient to justify a good deal of aggressiveness. The subject of psychiatry, the normality and abnormality of the human self, is a core definition of what a human being is or should be, what is human nature and what is alien to it and those core questions have never been adequately addressed or answered. Given that degree of uncertainty and that fundamental importance to our being, the reasonable ethical response in psychiatry ought to be caution and careful intervention. But antidepressants have saturated the adult market and become a staple in the US diet. Antidepressants have also moved into the pediatric market, often down to children no older than two years. We live in a society routinely and merrily drugging its children, and successfully dampening creativity, courage, confidence and all the messy behaviors associated with real learning. "

    Physicians routinely prescribe psychotropic drugs, often over many years, to their elderly patients. the benefits are doubtful and the negative effects are well established. In a review of physicians attitudes and prescribing practices, Damestoy et al stated: "the inappropriate use of medications by elderly patients has become a public health concern because of its prevalence and its potential impact on patient autonomy; physicians were unanimous in their view of the aging process as a very negative experience. "

    Some of the drugs prescribed are mild tranquillizers and sleeping pills that add to memory loss and confusion, relatively mild effects easily ignored in the elderly. However, other drugs are potent and may do irreparable harm to the elderly patients. The use of anti-psychotic drugs in the elderly is scandalous but common. These drugs will not correct aberrant behavior, improve cognition or memory but almost inevitably disable and further damage an already compromised brain.

    Patient demand has always driven the prescription drug industry to produce more chemicals and encouraged physicians to prescribe these chemicals. A modern well trained physician will understand that psychotropic drugs are mostly useful for brief interventions and that long-term use especially in men, women, children and the elderly is not desirable. some patients, on the other hand, become dependent on psychotropic drugs and demand renewed prescriptions over many years. Damestoy stated: "Many of the (elderly) patients had been using psychotropic medication for a long time, some for as long as 20 years. most physicians described a strong attachment of many of their patients, women in particular, to anxiolytic drugs (they) become demanding and difficult when their use of psychotropic drugs was questioned."

    Narcotic drugs have always been associated with addiction. The narcotic drugs remain the best agents to relieve pain. Physicians, however, remain constrained by problems of dependence, addiction and death by overdose. They are often reluctant to prescribe narcotics, or prescribe weak narcotics such as codeine and Demerol. Their concerns are justified. Prescribed narcotics are always available for sale on the street. About two million Americans have admitted taking OxyContin (oxycodone) illegitimately and the US Drug Enforcement Administration reported that it is one of the most abused prescription drugs. Another narcotic, hydrocodone also has a high potential for abuse. Both drugs act on the opioid mu receptor which blocks the transmission of pain in the spinal cord. In the USA OxyContin is a $1.5 billion per year product.

    Enserink, M .Drug Therapies for Depression: From MAO Inhibitors to Substance P. Psychopharmacology. Volume 284, Number 5412, Issue of 9 Apr 1999, p. 239.

    Important drug warning: Until further information is available, Paxil® (paroxetine hydrochloride) should not be used in children and adolescents under 18 years of age [Dear Health Care Professional Letter]. Mississauga (ON): GlaxoSmithKline Inc.; July 2003.

    Clements, C. You Got Drugs. Med Post. VOLUME 38, NO. 35, October 1, 2002

    Damestoy, N. Collin J. Lalande R. Prescribing psychotropic medication for elderly patients: some physicians perspectives. CMAJ July 27 1999; 161(2) 143-145

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