Peter Pringle's America: Pass the Prozac, Dr Smoothbrain

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The Independent Online
SUNNY, a golden retriever from Maryland, has made veterinary history. Her desire to chew on her paw as if it were a juicy bone was such that treatments, including salves, powders and warm doggie baths, had no effect.

Sunny's vet decided the poor creature's problem could be in her furry little head. He prescribed Prozac, the world's favourite antidepressant. Within two weeks, Sunny was transformed into a genial, happy dog, the envy of other anxious mutts and their veterinarians.

Eli Lilly, the makers of Prozac, never intended the drug to be used on animals, of course. Animals don't suffer from human-type depression, and there are limits to its application. Cats, for example, do not possess the liver enzyme required to metabolise Prozac, so the wonder drug has no application for those that scratch up furniture.

The Sunny episode may be more of a marvel than a future trend. The problem is that news about so-called miracle drugs travels fast, and before you know it, troublesome pets all over town will be popping pills, much like the troubled humans around them. Sunny's tale is also a reminder that the fix-it drugs may still only bandage the problem with a chemical plaster.

The next step from curing anxieties and depressions is off- the-shelf personalities. Neuroscientists, who in the Fifties began to identify the brain chemistry involved in depression, paranoia and schizophrenia, are now pinning down the chemistry of the normal personality. It is a laboratory revolution, they claim.

New drugs will be aimed not so much at those diagnosed as suffering from some clinically recognised illness, such as depression, but at perfectly normal people who want to alter their character in some way - enriching memory or improving concentration, for example.

The temptation to mess about with the chemistry of the brain - 'cosmetic psychopharmacology' - is as great as the desire to fool around with genes. People will want to eradicate shyness and hypersensitivity, curb impulsiveness and normal obsession, relieve normal anxiety, the blues and the affliction known in hyperactive children known by the faddish term ADD (attention deficit disorder).

The pressure on parents to slip their children a memory pill on the morning of school exams will be as intense as the desire of a sprinter to build muscles with steroids. In the workplace, office managers or floor supervisors will advise staff who are performing poorly to seek a pill that gives them a lift and allows them to complete the job in half the time.

But who is going to dispense these drugs, and should they be more carefully monitored? One in five American adults suffers a diagnosable mental illness in any six-month period, and American psychiatrists have been doling out pills by the barrow-load to those who can afford them. The number of psychiatrist visits in the US that resulted in a patient receiving a prescription for an antidepressant drug almost doubled between 1980 and 1989 - from 2.5 to 4.7 million. Much of the increase is attributed to the introduction of Prozac in 1988. Almost 4.5 million Americans, and another 4 million elsewhere in the world, have taken Prozac. Global sales total more than dollars US1bn.

But the Prozac boom also came as psychiatrists recognised that some antidepressant drugs could be used for disorders other than depression, including phobias and panic attacks.

Freudian psychiatry is under siege. By the late Eighties, offering a patient psychotherapy but no medication could result in charges of malpractice. More than half the psychiatric outpatients in a typical week are on medication, some without accompanying couch-therapy.

Fewer medical students than ever are choosing psychiatry as their speciality, and the leading psychiatric hospitals have cut their intake by as much as 50 per cent. Psychiatrists' pay, which used to compare well with all medical specialists, is now among the lowest.

The on-going shift from couch to pill is a long and complicated one, but two trends are clear. First, other professionals - psychologists, social workers and psychiatric nurses who qualify much quicker than the 18 years it can take to become a psychiatrist - offer help often at half-price. Non-medical mental health physicians now outnumber psychiatrists three to one. Second, local GPs now prescribe up to 65 per cent of popular antidepressants such as Prozac.

However you view psychiatrists, and whatever you may feel about the efficacy of pharmocology - and by most accounts the pills have been a boon to mental health - you have to wonder about the new 'miracle' drugs that change the nature of 'self' as easily as a bust measurement, a crooked nose or a sagging jowl, and turn humans into smoothbrains with no angst to overcome. What price individuality or creativity?

Perhaps the answer is to pass out more Prozac to the doggie set, where its apparent ability to calm an animal will give humans a better idea of what could happen to them. Certainly, there are Rottweilers out there who would benefit from a dose or two.

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