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Drugs & Alcohol
  1. Introduction
  2. Mysterious mechanism
  3. Smart Drugs: Ethical Issues
  5. Nobody can agree about antidepressants. Here’s what you need to know | New Scientist

Within six weeks, she was on the road to recovery. Global antidepressant use is soaring. Experts, meanwhile, disagree over whether the drugs genuinely have the biochemical effects claimed for them and debate rages about side effects, withdrawal symptoms and the possibility of addiction.


So what should we believe — and who, if anyone, should be taking these pills? For a long time, doctors could do little to help, but by the s, the first medicines emerged. Prime among them were so-called tricyclic antidepressants. They were less than ideal, causing side effects such as weight gain and drowsiness. They were generally reserved for the most severe cases.

Things changed with the launch of Prozac in It was the first of a class of drugs known as selective serotonin reuptake inhibitors SSRIs that are said to work by boosting levels of a brain-signalling molecule called serotonin. Prozac was safer than its predecessors, less likely to cause side effects, and had to be taken just once a day. Sales quickly took off.

Mysterious mechanism

In , the pale green and white capsules made the cover of Newsweek. The number of conditions they were used for grew to include anxiety, panic attacks and obsessive-compulsive disorder. Today, around 40 antidepressants are available, and they are among the most commonly prescribed drugs in many Western countries. Between and , prescriptions increased in all 29 countries surveyed by the Organisation for Economic Co-operation and Development, on average doubling. For some, the rise in antidepressant use is a welcome sign that the stigma surrounding mental health problems is in decline and more people are prepared to seek medical help.

Smart Drugs: Ethical Issues

But not everyone accepts this narrative. The drugs do raise serotonin levels in the junctions between brain cells, but there is no consistent evidence that people with depression have less serotonin than others. There is even less evidence that SNRIs work by correcting an imbalance of noradrenaline. Even most sceptics agree that antidepressants have psychological effects.

These vary from person to person, but many describe a slight dampening of their emotions — a feeling of being chilled out. Yet strangely, although the flattening happens quickly, within days or sometimes even hours of the first dose, depression itself usually does not abate until several weeks later, as if it takes time for people to relearn their old ways. One alternative explanation for how antidepressants work is that they boost the growth of new brain cells, which takes weeks.

On top of their mysterious mechanism, there is also controversy about just how many people benefit from antidepressants. That stems from work by Irving Kirsch , a psychologist at Harvard Medical School, beginning in the s. He says he initially had nothing against antidepressants and sometimes recommended them to his psychotherapy clients. Kirsch was studying the placebo effect , the mysterious improvement in some cases of illness, apparently by the power of mind over matter, after people take medicines known not to work.

Antidepressants had been known for decades to show a much bigger placebo effect than other commonly prescribed medicines such as antibiotics — a case of mind over mind. When Kirsch and his colleagues pulled together results from many different trials that compared antidepressants with placebo tablets, they found that about a third of people taking placebo pills showed a significant improvement. This was as expected. Aside from the classic placebo response, it could have been due to things such as the extra time spent talking to doctors as part of the trial, or just spontaneous recoveries.

What was surprising was how people on antidepressants were only a little more likely to get better than those on the placebos. They have since been reproduced in several other analyses, by his group and others. As a result, some clinical guidelines now recommend medication only for those with severe depression, where meta-analyses suggest a bigger benefit. But these are no panacea, and the wait for such treatment on the NHS can be many months. In practice, pills are often still the first resort in the UK and many other places.

For mild or moderate depression, UK, Australian and New Zealand guidelines among others recommend talking therapies such as cognitive behavioural therapy. Towards responsible use of cognitive-enhancing drugs by the healthy. Nature, , — Guardian Student Blog Habermas, J. The future of human nature trans: W.

Rehg, M. Pensky, and H. Cambridge: Polity. Harris, J. Enhancements are a moral obligation. Heal, D. Methylphenidate and its isomers: Their role in the treatment of attention-deficit hyperactivity disorder using a transdermal delivery system. CNS Drugs, 20 9 , — Heinz, A. Cognitive neuroenhancement: False assumptions in the ethical debate. Journal of Medical Ethics, 38 6 , — Epub Jan 6. Holloway, K. Prescription drug misuse among university staff and students: A survey of motives, nature and extent. Drugs Education Prevention Policy, 19 , — Hyman, S. Cognitive enhancement: Promises and perils.


Neuron, 69 4 , — Illes, J. Neuroethics: Defining the issues in theory, practice, and policy. Juengst, E. Can enhancement be distinguished from prevention in genetic medicine? Journal of Medicine and Philosophy, 22 2 , — Kramer, P. Listening to Prozac: A psychiatrist explores antidepressant drugs and the remaking of the self. New York: Viking. Maher, B. Nordmann, A. If and then: A critique of speculative nanoethics. NanoEthics, 1 , 31— Nutt, D.

Development of a rational scale to assess the harm of drugs of potential misuse. Lancet, , — Parens, E. Creativity, gratitude, and the enhancement debate. Illes Ed. Toward a more fruitful debate about enhancement. Partridge, B. PLoS One, 6 11 , e Beyond therapy: Biotechnology and the pursuit of happiness. New York: Dana Press.

Nobody can agree about antidepressants. Here’s what you need to know | New Scientist

Quednow, B. Ethics of neuroenhancement: a phantom debate. BioSocieties, 5 , — Ragan, C. What should we do about student use of cognitive enhancers? I find it interesting that he dismissed the role of a shaman and says that anyone can brew ayahuasca in the house. I wonder why that is. Great podcast, as always with many inspirational ideas! Also, nice thoughts about the smart drugs not actually making you smarter. The part I got upset with was what your interviewee said about ritaline — being addictive and that you could have the same effects of clarity with discipline, because it puts quite a heavy stigma on people who rely on this substance because of ADHD. Concentration problems caused by dopamine imbalance are sure not to be solved with more discipline — discipline can be useful in general, but it does not provide the dopamine level needed for the brain to filter out distractions the same way an average brain does.

Actually you would assume that someone without ADHD who takes ritaline would indeed feel stimulated by the extra dopamine — awake, a little jittery, a little euphoric, so they might feel more motivated to go on reading and studying for hours, but the actual ability to concentrate and memorize actually gets worse with too high levels of dopamine.

Treat agitation or severe anxiety states with diazepam or midazolam. Butyrophenones such as haloperidol are useful despite a small theoretic risk of lowering the seizure threshold. Treat seizures, hyperthermia, rhabdomyolysis, hypertension, and cardiac arrhythmias if they occur. New York, N.

I loved this episode.

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And any of your podcasts that explore alternative medicines. How about interviewing a Shaman or someone who can speak about shamanism as it relates to the medicines. Merging the science with the spiritual. I have some ideas. But hate to name drop on an open forum. Not sure which episode it was mentioned in but looking for recommendation on mujo.