Monday, March 06, 2006
It has been reported that some nondepressed persons taking SSRI antidepressant medication become better than well. Some may argue that there is a problem with such a mental state. One of the arguments is that such a mental state is not authentic, and thus it is to be avoided. It turns out, though, that for the vast majority of persons, any such enhancement is subtle. In fact, it is barely measurable. Certainly, no one has documented any large flux of nondepressed persons flocking in to their doctors, trying to get prescriptions for SSRIs. Granted, there is no reliable way to prove that it isn't happening, but it is hard to base an argument on evidence that does not exist. Could it happen? Sure: it would not be difficult for someone to read up on the symptoms of depression, and go in to get a prescription. Moreover, someone could order such medications over the Internet, without a prescription (which I don't recommend, by the way.) Having said that, I am fairly sure that the majority of physicians would not expect this to happen. The most likely outcome, if a person were to try this, would be for the person to take the medication for a few weeks, maybe months, then stop. Any changes probably would be so small that they would not be apparent to casual observation. In order to see the changes, one would have to do careful studies of various parameters, and take averages among a large group. The changes in any one individual probably would be so small as to be clinically insignificant.
If we agree that any such changes are small, does that make the ethical concern go away? In my view, it does. For those who still wonder, consider the following study on nonpharmaceutical compounds, as noted on the blog, Crumb Trail:
Omega 3 fatty acids influence mood, impulsivity and personality, study indicatesNote that the study participants were identified as "healthy volunteers," so presumably none had a diagnosable mood disorder (See this link for more detail on the study). The study is suggestive (although not conclusive) in that it does not tell us for sure whether a healthy person could become better than well by deliberately increasing the intake of omega-3 fatty acids. Although not conclusive, the study raises the question: if deliberate dietary supplementation with an ordinary food can cause a person to be better than well, is that better-than-well mood state inauthentic? Or is the enhanced mood state inauthentic only if it is produced by an artificial chemical? If there seems to be a difference in authenticity, why does the source of the chemical matter?
DENVER, March 3 – Omega-3 polyunsaturated fatty acids may influence mood, personality and behavior, according to results of a study presented today by University of Pittsburgh School of Medicine researchers at the 64th Annual Scientific Meeting of the American Psychosomatic Society in Denver.
In a study of 106 healthy volunteers, researchers found that participants who had lower blood levels of omega-3 polyunsaturated fatty acids were more likely to report mild or moderate symptoms of depression, a more negative outlook and be more impulsive. Conversely, those with higher blood levels of omega-3s were found to be more agreeable.
"A number of previous studies have linked low levels of omega-3 to clinically significant conditions such as major depressive disorder, bipolar disorder, schizophrenia, substance abuse and attention deficit disorder," said Sarah Conklin, Ph.D., a postdoctoral scholar with the Cardiovascular Behavioral Medicine Program in the department of psychiatry at the University of Pittsburgh School of Medicine. "However, few studies have shown that these relationships also occur in healthy adults. This study opens the door for future research looking at what effect increasing omega-3 intake, whether by eating omega-3 rich foods like salmon, or taking fish-oil supplements, has on people's mood." [emphasis added]
Credit goes to aspazia for the inspiration for this post, as well as some of the background information.
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This doesn't speak to your point about sources, it's just a technical neep, but it changes the issue a bit from "better-than-well" to "better-than-normal", where normal is in fact less than fully well.
1. I have to say that, even without SSRIs, there some people that really irritate me, because they're excessively happy. So maybe there have always been those who are more well than well.
2. It's an interesting experience to have some old curmudgeon in Rehab (physical rehab) for something or other, and in the process you talk to the family and pretty clearly get a history that this guy has been hostile as a manifestation of lifelong depression. So you put him on an SSRI, and he changes. He changes so much that suddenly the family has a different person they're taking home, like aliens came and replaced their husband/father. And to some extent, you're not sure they can adjust to the "new" guy.