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 - - - - - - - - - - - - - - - - - - - - - -= =20 =20