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Happiness pills
The last word Happiness pills John McCrone http://www.btinternet.com/~neuronaut/
This guy sidled up to my elbow at a neuroscience conference a few years back. His smile was oddly stretched and he kept looking deep into my eyes. So what was he selling? Happiness as it turned out. A family practitioner from Los Angeles, California, USA, he believed that everyone should be happy with a capital H. And, as a doctor, he was exploring the pharmacological route to this goal. Not only was he self-prescribing this new drug called Prozac (fluoxetine hydrochloride) but he was titrating it with a whole medical chest of brain nutrients and smart drugs—so-called nootropics. There were acetylcholine substrates such as dimethylaminoethanol, brain circulation boosters such as hydergine, and Deprenyl (selegiline hydrochloride; used to treat Parkinson’s disease), which he was particularly keen on as an energiser and creativity releaser. A regimen of perhaps a dozen different pills was popped each day. Combined with yoga, meditation, and a macrobiotic diet, he was a really, really, happy person, he told me, almost bursting with the strain of projecting the requisite beatific contentment. First gently, then increasingly bluntly, I mounted the standard European counter-argument. Life is about its highs and lows, ebbs and flows. A dynamic range. His dreams of chemically enforced positivity were creepy, even inhuman. He flinched, his rictus smile becoming even tighter. But open scoffing only seemed to convince him that he was my new best friend. For the rest of the week I was dogged by shy nods and little waves across the conference throng. Nootropics have of course turned into a flourishing cottage industry since then. It is but a small step from a passing mention of a chemical in the pages of a neuroscience journal to websites offering you a discrete postal service. The other day I did an internet search on anisomycin—an antibiotic injected into the amygdala of rats during fear-conditioning experiments because it has the side-effect of blocking the production of proteins involved in the formation of long-term memories. The very first site was a nootropic one with the banner: “Getting rid of bad memories—the countdown has begun”. Well, I just hope they supply customers with a sturdy syringe and brain atlas as well.
260
As a cynical European, it’s always nice to have the last laugh. And recent news that the placebo effect may account for a whopping 80% of the potency of antidepressants like Prozac does indeed produce a bit of a quiet gloat. University of Connecticut psychologist Irving Kirsch used the Freedom of Information act to get access to all drug trials for US Food and Drug Administration approval of the six most widely prescribed antidepressants. These included “file drawer” studies not put forward for publication. A meta-analysis of 47 trials showed that the placebo control did about as well as the drugs at changing the mood of patients (Prevention and Treatment 2002, 5: article 33 http://journals.apa.org/ prevention/volume5/pre005 0033r.html). Paxil came out best, being 30% more effective than placebo, while that great pharmaceutical success story, Prozac, did worst scoring scarcely 10% better than placebo. Kirsch says there are no getout clauses like the idea that only the real drugs work with serious cases of depression, or that only the real drugs work long term. On the basis of his figures, placebo does nearly as well no matter how you slice it. Indeed, if the placebo pills could be given a few unpleasant side-effects to make them more convincing as fake pharmaceuticals, then perhaps the last small margin of the real SSRIs might disappear! The arguments are still going back and forth over this one as it is, in truth, hard to believe that Prozac and the like can really be doing so little. But either way the manufacturers look bad. Either the drugs don’t work. Or FDA trials don’t properly test efficacy. So not so funny really. However when it comes to smart drugs and happiness pills for people with a relatively normal neurochemistry, it does become quite easy to believe that the placebo effect is probably the whole of the effect. The likes of ginkgo biloba or hydergine may get the body buzzing a little. They might produce some peripheral arousal. And if pill-poppers of, shall we say, the Californian persuasion, take this as an indication that they are feeling super sharp that day, simply bursting with vitality and joy, then good luck to them. But for myself, I’ll continue to medicate with the rather more traditional continental psychoactives like coffee, wine, and brisk walks.
THE LANCET Neurology Vol 2 April 2003
http://neurology.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.
This guy sidled up to my elbow at a neuroscience conference a few years back. His smile was oddly stretched and he kept looking deep into my eyes. So what was he selling? Happiness as it turned out. A family practitioner from Los Angeles, California, USA, he believed that everyone should be happy with a capital H. And, as a doctor, he was exploring the pharmacological route to this goal. Not only was he self-prescribing this new drug called Prozac (fluoxetine hydrochloride) but he was titrating it with a whole medical chest of brain nutrients and smart drugs—so-called nootropics. There were acetylcholine substrates such as dimethylaminoethanol, brain circulation boosters such as hydergine, and Deprenyl (selegiline hydrochloride; used to treat Parkinson’s disease), which he was particularly keen on as an energiser and creativity releaser. A regimen of perhaps a dozen different pills was popped each day. Combined with yoga, meditation, and a macrobiotic diet, he was a really, really, happy person, he told me, almost bursting with the strain of projecting the requisite beatific contentment. First gently, then increasingly bluntly, I mounted the standard European counter-argument. Life is about its highs and lows, ebbs and flows. A dynamic range. His dreams of chemically enforced positivity were creepy, even inhuman. He flinched, his rictus smile becoming even tighter. But open scoffing only seemed to convince him that he was my new best friend. For the rest of the week I was dogged by shy nods and little waves across the conference throng. Nootropics have of course turned into a flourishing cottage industry since then. It is but a small step from a passing mention of a chemical in the pages of a neuroscience journal to websites offering you a discrete postal service. The other day I did an internet search on anisomycin—an antibiotic injected into the amygdala of rats during fear-conditioning experiments because it has the side-effect of blocking the production of proteins involved in the formation of long-term memories. The very first site was a nootropic one with the banner: “Getting rid of bad memories—the countdown has begun”. Well, I just hope they supply customers with a sturdy syringe and brain atlas as well.
260
As a cynical European, it’s always nice to have the last laugh. And recent news that the placebo effect may account for a whopping 80% of the potency of antidepressants like Prozac does indeed produce a bit of a quiet gloat. University of Connecticut psychologist Irving Kirsch used the Freedom of Information act to get access to all drug trials for US Food and Drug Administration approval of the six most widely prescribed antidepressants. These included “file drawer” studies not put forward for publication. A meta-analysis of 47 trials showed that the placebo control did about as well as the drugs at changing the mood of patients (Prevention and Treatment 2002, 5: article 33 http://journals.apa.org/ prevention/volume5/pre005 0033r.html). Paxil came out best, being 30% more effective than placebo, while that great pharmaceutical success story, Prozac, did worst scoring scarcely 10% better than placebo. Kirsch says there are no getout clauses like the idea that only the real drugs work with serious cases of depression, or that only the real drugs work long term. On the basis of his figures, placebo does nearly as well no matter how you slice it. Indeed, if the placebo pills could be given a few unpleasant side-effects to make them more convincing as fake pharmaceuticals, then perhaps the last small margin of the real SSRIs might disappear! The arguments are still going back and forth over this one as it is, in truth, hard to believe that Prozac and the like can really be doing so little. But either way the manufacturers look bad. Either the drugs don’t work. Or FDA trials don’t properly test efficacy. So not so funny really. However when it comes to smart drugs and happiness pills for people with a relatively normal neurochemistry, it does become quite easy to believe that the placebo effect is probably the whole of the effect. The likes of ginkgo biloba or hydergine may get the body buzzing a little. They might produce some peripheral arousal. And if pill-poppers of, shall we say, the Californian persuasion, take this as an indication that they are feeling super sharp that day, simply bursting with vitality and joy, then good luck to them. But for myself, I’ll continue to medicate with the rather more traditional continental psychoactives like coffee, wine, and brisk walks.
THE LANCET Neurology Vol 2 April 2003
http://neurology.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.