DEATH OF A DREAM? THE SPECTRE OF ADDICTION COULD BURST THE PROZAC BUBBLE

THE world's love affair with the antidepressant drug Prozac could end in
tears, according to a report written independently by a member of the WHO's
Advisory Panel on Drug Policies and Management. Charles Medawar says that
the side effects of Prozac and its relatives have been underestimated, the
drugs may be addictive and they are not as effective as was first hoped.

Prozac is the best known of several drugs called selective serotonin
reuptake inhibitors, which treat depression by boosting levels of the
neurotransmitter serotonin in nerve synapses. SSRIs have been on sale in
Britain for 10 years. In that time they have racked up 17,845 official
reports of adverse effects from GPs.

Ralph Edwards, director of the WHO's Collaborative Centre for International
Drug Monitoring in Uppsala, Sweden, says: "I don't always agree with
Medawar's interpretations, but there's something strange going on with a
drug when you have a huge number of side effects reported but little done
about it."

Medawar says that, like benzodiazepine drugs such as Valium and Mogadon,
SSRI antidepressants can cause dependence. He says doctors mistake symptoms
caused by the drugs' withdrawal for signs of relapse.

The extent of benzodiazepine addiction was only discovered when doctors
realised that the drugs' withdrawal symptomsinsomnia, tension and
depressionwere identical to those they were supposed to treat. Yet a
review of safety data by Medawar reveals that since 1963, 230 million
prescriptions of the two main benzodiazepine drugs temazepam and diazepam
in Britain have generated just 25 official notifications of withdrawal
reactions. In under 10 years, 5 million prescriptions of an SSRI called
paroxetine generated 802 notifications.

Malcolm Lader, professor of psychopharmacology at the Institute of
Psychiatry in London, is cautious about Medawar's conclusions: "I think he
takes the comparison between benzodiazepines and SSRIs too far. Withdrawal
symptoms and dependence are not necessarily the same thing."

Lader says that patients have not been shown to crave SSRIs when they are
withdrawn. "But I agree with him that the efficacy of SSRIs has been
disappointing," he says. Medawar cites two studies, each of which looked at
more than 60 trials. "These showed that SSRIs do have the edge on
alternatives, but not by much."

Both studies used the number of patients who gave up taking the drugs as an
indicator of efficacy. The first study found that 5 per cent fewer patients
on SSRIs dropped out of the trials compared with those taking alternatives,
while the second study showed a difference of only 3 per cent.

Medawar's report is published in The International lournal of Risk and
Safety in Medicine (vol 10, p 75).