In the interests of gaining a more balanced take on SSRI's after reading "Listening to Prozac" I've just started reading "Prozac Backlash"

http://www.amazon.com/Prozac-Backlas.../dp/0684860015

Joseph Glenmullen (psychiatrist) discusses evidence (and case reports) that Prozac (and other SSRI's) can cause side effects including permanent neurological damage and withdrawal syndromes. While he is a little unfair to Kramer in not seeing that he raises important ethical issues for (possible) future developments in pharmaceuticals he does offer a decent discussion of the evidence that is available for the dangers of SSRI's.

In particular, I was taken with the section entitled 'The 10-20-30 Year Pattern'.

'Unfortunately, the dangerous side effects emerging with Prozac, Zoloft, Paxil, and other serotonin boosters are right on schedule, appearing like clockwork in a 10-20-30 year pattern characteristic of popular psychiatric drugs. The first potent antidepressants of the modern era were cocaine elixirs, introduced in the late 1800's. At the turn of the century cocaine elixirs were the most popular prescription medications, prescribed for everything from depression to shyness, just as the Prozac group are today. Freud wrote three famous "cocaine papers" advocating the drug's use. Since cocaine elixirs, we have had numerous amphetamines, bromides, barbiturates, narcotics, and tranquilizers, all hailed as miracle cures until their dangerous side effects emerged.

Reviewing the history of these drugs, one finds a strikingly similar pattern: Initially, the drugs are aggressively marketed with claims they are revolutionary breakthroughs, remarkable scientific advances over predeccessors. Early on, a few doctors champion their cause, becoming celebrities along with the drugs. Often, a handful of celebrities step forward to endorse the miracle cure. As they gain momentum, use of the drugs spreads beyond the confines of psychiatry and they are prescribed by general practitioners for everyday maladies. Indeed, the burgeoning list of "conditions" they are used to treat, including everyday life, is often one of the first clues that one is looking at a general mood brightener that provides a quick fix.

In the typical life span of the drugs, the earliest signs of problems appear about ten years after introduction. Pharmaceutical companies and proponents deny the problems, adopting the strategy of defending the medication to the last. As we lack serious long-term monitoring of side effects and rely almost entirely on spontaneous, volountary reporting by doctors, it is typically only at the twenty-year mark that enough data has accrued for the problems to be undeniable and for a significant number of physicians to be sounding the alarm. Still another ten years or so elapse before professional organizations and regulatory agencies actively take steps to curtail overprescribing. Thus, the cycle from miracle to disaster typically takes thirty years or more. By then, even the most popular drugs are no longer covered by their patent and even their manufacturers have an incentive to abandon medications that have become passe and disreputable. Typically their energies are then focused on the next breakthrough: newly patented, more profitable agents, which can be promoted as "safer" because their hazards are not yet known". pp.12-13

I found his description of the see-saw relationship between the serotonin and dopamine systems to be interesting. The trouble I had with Breggin's 'Toxic Psychiatry' was that I didn't understand how he was able to claim that SSRI's were toxic similarly to anti-psychotics (which he made a fairly good case for). The idea here is that even if the drug has a 'selective action' (as SSRI's do in selectively boosting serotonin) the brain attempts to compensate / return to homeostasis by decreasing dopamine (resulting in 'extra-pyrimal' parkinson's symptoms (tardive dyskinesias and dementias) that one sees in response to anti-p's).

Desire to take SSRI's: Removed.

Another thing that I found interesting was this, however:

'Each year the FDA reviews about 25 new drugs for approval. For this task, the agency has a professional staff of 1,500 doctors, scientists, toxicologists, and statisticians. But to monitor the safety of the more than 3,000 drugs already on the market and being prescribed to millions, the agency has a professional staff of just 5 doctors and one epidemiologist. Because long-term monitoring is virtually nonexistent, in a 1993 article in the Journal of the American Medical Association, the then commissioner of the FDA, David Kessler, revealed that "only about 1% of serious events [side effects] are reported to the FDA. The FDA itself is not responsible for this state of affairs, says Thomas Moore, a leading authority on drug side effects at the George Washington Medical Centre. The FDA's budget is set by Congress.

So... Looks like the government is regulating the pharmaceutical industry (or allowing it to be dys-regulated) after all...