The sober reality of ‘happy pills’
The pursuit of happiness – enshrined as an “inalienable right” in the US Constitution – can be elusive for many. Hence the considerable scientific interest, as described in this paper last week, in novel (if previously frowned-on) mind-boosting drugs, including the street drug ketamine and psilocybin, the active ingredient of magic mushrooms.
In reply to a question at PMQS, Boris Johnson said he would look into the legalisation of psilocybin, which would potentially put it in the same category as medical cannabis.
For the indefinite future, Prozac and similar “happy pills”, which are now taken by three million people in Britain, remain the cornerstone of antidepressant drug therapy – so it is only sensible that doctors know how to prescribe them appropriately.
What, for example, to make of the recent much commented-on study conducted in 150 GP surgeries that found long-term medication to be “beneficial”? In a nutshell, monitoring the outcome in patients who had been taking antidepressants for at least three years, the GPS reported that 56 per cent of those who discontinued them experienced a recurrence, within a year, of their psychological symptoms. The implication that, on balance, it is better to “keep taking the pills” must be qualified by noting that for nearly half this would be the wrong decision, as they were able to come off them successfully.
The further crucial qualification is that the efficacy of Prozac et al is predicated on their boosting levels of the neurotransmitter serotonin in the brain. Thus, as with other psychostimulants such as alcohol and opiates, stopping them can result in a withdrawal syndrome, described by one woman as “physical and emotional turmoil, dizziness, exhaustion, electric shock sensations and suicidal thoughts”. This syndrome can be misinterpreted as being due to a recurrence of the original depressive illness, which could account, at least in part, for that high incidence of relapse reported in the GPS study.
This all puts a rather different gloss on the “benefits” of long-term medication. Those taking Prozac et al should check out an interesting article by Stevie Lewis, challengingly titled “Four research papers I wish my GP had read before prescribing antidepressants”, published in the British Journal of General Practice (and available on its website). Based on Lewis’s experience of having taken antidepressants for 15 years, it provides an informed perspective on the complexities and ambiguities surrounding this (for some) most useful class of drugs – along with guidance on how to minimise the effects of that withdrawal.
Spidey sense
Regarding last week’s query about the presence of a spider’s web across the field of vision, an eminent ophthalmologist observes that it is a natural process caused by agerelated changes in the consistency of the jelly-like vitreous in the eyeball, which keeps it round and bouncy. With time, this vitreous becomes more liquid, forming pockets of fluid and strands, as well as becoming less firmly attached to the back of the eye. These, in turn, interrupt the waves of light entering the eye, causing shadows to fall on the retina that are perceived as “floaters”, or a stippled pattern like a spider’s web.
This is technically (if rather alarmingly) known as “posterior vitreous detachment”, but is of no significance on its own account – usually resolving spontaneously, as the visual cortex of the brain, in some miraculous way, accommodates to those extraneous shadows. They can, however, if rarely, be a harbinger of more serious problems when the contracting vitreous pulling on the retina causes it to detach completely from the back of the eye, perceived as a large black patch obscuring the visual field.
“This happened to me,” writes one reader, who was “lucky enough” to have reattachment surgery the following day. The further potentially serious development is the sudden appearance of numerous tiny “floaters” – likened to gnats or pepper grains. These are, in fact, red blood cells leaking from a vessel within the eye and, as with the dark patch of retinal detachment, warrant prompt medical attention.
Three million Britons take the pills, so doctors need to know how to prescribe them