This is an article from today's (3/23/98) Boston Globe that may be of=20
interest in the ongoing discussion of depression.=09
                                                                Peace, John
**********************
Prozac-like drug use for the healthy stirs debate=20

By Dolores Kong, Globe Staff, 03/23/98=20

For the first time, a study has documented that Prozac-like drugs can alter
the personality of healthy people - a finding that goes right to the heart
of a growing debate over use of the antidepressants to modify normal,
everyday traits. In the study, researchers found the people who had no
symptoms of depression or other mental illness were less aggressive and
generally felt less ''blue'' when they were given Paxil, a drug in the same
class with Prozac. The drug also made them more socially cooperative, the
scientists reported in the March issue of the American Journal of=
 Psychiatry.=20

 While the research was designed only to explore fascinating questions
about the neurochemistry of normal personality, it already has added fuel
to the controversy over the potential of the drugs to change personality
traits.=20

''We have at hand the possibility to take people from one normal but less
 desired state to another normal but more desired state,'' said Peter D.
Kramer, a Rhode Island psychiatrist who wrote ''Listening to Prozac,'' a
bestseller that has spurred much of the discussion. ''Whether it's scary or
not is sort of a large question,'' he said. So intriguing a question, at
least, that a group of bioethicists from around the world have joined to
examine the issues raised, and psychologists, psychiatrists, and others are
actively pursuing it as well.=20

Should the drugs be viewed as harmless ''cosmetic psychopharmacology'' -
a phrase coined by Kramer to describe the potential for people to use the
pills to ''improve'' their personality, as they use cosmetic surgery to
improve
their physical appearance? As ''enhancement technology'' - a phrase used by
the bioethicist group to describe the use of everything from Prozac to
steroids not to treat sickness, but to boost ''performance?''

Or should their use be viewed as a challenge to individuals' sense of self,=
 by
enabling them to change their feelings and personality by simply popping a
pill, rather than through introspection and self-understanding, as some
ethicists and others concerned about overuse believe? Complicating the
issue are the health care market forces that pressure psychiatrists and
other physicians to prescribe antidepressants rather than psychiatric
approaches.

''As we go through life, it's inevitable that something makes us sad or
depressed. It's not necessarily something that needs to have a chemical
thrown at it,'' said Paul K. Ling, a Quincy psychologist and a leader in the
Consortium for Psychotherapy, an interdisciplinary group of Massachusetts
clinicians working to ensure the quality of psychotherapy is maintained.=20

''We all go through a grief reaction at some point. We all lose someone we
love and feel depressed and down. That's sort of the normal maturational
process that a human being needs to go through,'' said Ling, who as a
psychologist cannot prescribe drugs but laments the market forces that many
say have led to overreliance on medications and the declining use of
longer-term psychotherapy.=20

While Ling acknowledged that the new study into the neurochemical
underpinnings of the normal personality is valid scientific research, he
worries about the potential for the drugs to be misused, not just by
individuals, but by institutions. ''I think there are many governments in
this world who would
like to have a docile population,'' he said. ''I find that a little bit
scary. You're talking about a potential lever as far as social control is
concerned,'' Ling said. ''It has overtones of `Brave New World.'''

 Dr. Victor I. Reus, a professor of psychiatry at the University of
California in San Francisco, and one of the study authors, agrees that
market forces have
led to wide use of the drugs, even though they have been approved only for
the treatment of depression. ''In managed care, it's more efficient and
cheaper to provide psychiatric drugs,'' he said. But Reus declined to give
an opinion about the drugs' use in healthy people.''I refrain from entering
that debate, it's so socially charged,'' he said. ''It's a judgment that
has to sort of be arrived at by society. As to whether it's good or bad,
that's not sort of a scientific or neurochemical conclusion.''=20

Reus did, however, compare the drugs to other mood-altering substances in
wide use. ''There's a natural experiment that goes on in every culture,=
 every
day. People use caffeine, nicotine, alcohol, to modulate their social
behavior,
to modulate their mood. Clearly, that's sort of a similar phenomenon. People
come home in the evening and have a martini because they want to feel more
relaxed. It may help them become more outgoing, less stressed, less=
 irritable,
more available to family members.''

And, he added, while some people might think that prescribing the drugs to
moderate aggression or overly-competitive or edgy behavior is a valid use,
''I don't know if you want an airline pilot to be more casual about the
sort of
checklist he has before he takes off, or about the weather conditions.''

The study, whose lead author is Brian Knutson, now with the National
Institutes of Health, is the first to document that the class of drugs
known as
selective serotonin reuptake inhibitors, or SSRIs, affects people who have
no mental illness, although anecdotal reports appear in Kramer's ''Listening
to Prozac'' and elsewhere.=20

The drugs block the reabsorption of serotonin, thus boosting available=
 levels
of the mood-altering brain chemical. Research has found low levels of
serotonin in people who are depressed, suicidal, or aggressive.=20

For their study, Reus and colleagues chose Paxil, or paroxetine, rather than
the earlier-approved Prozac, because it appears to be more specific in its
action against serotonin reabsorption.=20

''It did have an effect on reducing hostility and irritability,'' said
Reus. He said the effect was measured with psychological questionnaires
given to the 48
volunteers before and after the four-week study. The drug also improved the
volunteers' social cooperativeness, as measured by a lab experiment in
which they were observed working with a partner to piece together a puzzle.

''Interestingly, it did not improve people's mood. It did not make them
euphoric,'' Reus said. Paxil was not without side effects, however, among
them significant sleepiness and delayed orgasm. Researchers do not know if
the drug's effects - the positive as well as the negative - are=
 long-lasting.=20

As beneficial as reducing hostility and irritability might seem for some,=
 the
team of ethicists looking into the use of Prozac and other ''enhancement
technologies'' by healthy people say there are some serious questions to be
thought through by society.=20

''Is there anything wrong with wanting to be taller, or better-looking, or
happier, or to be able to concentrate better? Should we be worrying about
any of this?'' Dr. Carl Elliott of the University of Minnesota's Center for
Bioethics and leader of the international team of ethicists, asked in a
lecture
last month. His group is called the Enhancement Technologies Group and is
funded by the Social Sciences and Humanities Research Council of Canada.

We should, indeed, he said. With cosmetic surgery, growth hormones and
stimulant drugs such as Ritalin so readily available, they will prove an
irrestible lure for many people willing to pop pills or undergo procedures=
 so
they can look, feel or act a certain way, according to the social norms or
marketing pressures of the day, Elliott said.=20

These medical technologies, he said, raise questions about the very nature=
 of
human identity. ''Today, it is very easy to speak of any disagreeable=20
personality trait as if it were an illness - and even some that are not so=
=20
disagreeable, like shyness, which is being discussed more and more often in
the=20
ethical and psychiatric literature as if it were some kind of mental
disability,'' he said. ''We have redefined identity as illness.''

                  This story ran on page C01 of the Boston Globe on=
 03/23/98.=20
                  =A9 Copyright 1998 Globe Newspaper Company.=20

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