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 Valium as a sedative-tranquilizer has been replaced by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)
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