Depression drugs make record sales for

Over-prescription 'belittles mental illness', John Morrish is told

SOARING sales of drugs that act on the central nervous system - especially anti-depressants - have made them one of the fastest-growing sectors of the global pharmaceutical market. Figures just published show that sales increased worldwide by 13 per cent last year.

A report by the health information company IMS Health last week showed that sales of drugs for the central nervous system increased in the year to February to a world total of $25.5bn (pounds 16bn). Many of these drugs were for physical ailments with no psychiatric component. But sales of anti- depressants, worth $435m in Britain last year - 20 per cent up on 1996 - continue to rise.

To Kay Redfield Jamison, the leading authority on manic depression and other mood disorders, this is a clear indication of overprescription and the use of drugs as an easy solution to emotional trauma. In the wake of the Prozac hype, she believes, mental illness is being belittled.

Dr Jamison, professor of psychiatry at the Johns Hopkins University school of medicine in Maryland and author of Manic-Depressive Illness, the standard textbook on the subject, is worried that the Prozac phenomenon "can trivialise very severe mental illness by making it all look like the same thing. You know, 'You're a little depressed, that means you need medicine.' Well, of course, you don't. I think we're trivialising human nature and trivialising medicine".

She adds: "I think there's no question that there has been overprescription of anti-depressant medication, but overwhelmingly, if you look at the epidemiology, people have been underprescribed. There are far more people with severe depression who don't get treated at all than people who have mild depression who are getting medication they don't need to be on.

"And these are not benign drugs. These are very major drugs with major impacts on the brain. People shouldn't be on them unless they need them."

Dr Jamison is in a better position to speak about these matters than many psychiatrists. In 1996 her autobiography, An Unquiet Mind, revealed that throughout her rise to the heights of American psychiatry and eminence as an authority on manic depression, she herself suffered terribly with the condition of mood swings from depression to elation and even psychosis. She once attempted to commit suicide during a bout of depression. After two severe manic episodes she discovered that wild spending had left her $30,000 in debt.

Her candour has brought her a strong following among sufferers and their relatives. Last week she was in London to give a talk on illness and creativity at the Royal Festival Hall. "Most of the questions I get, no matter what the topic, tend to be clinical. 'What about this drug? What's the illness likely to turn into? Does it get worse?'"

She subscribes to an unambiguously medical model of mental illness, especially manic depression. "Absolutely," she insists. "It's a medical disease. It's just unfortunate that the symptoms are behavioural and cognitive and involve mood, so it looks less biological than it is."

Dr Jamison accepts the value of psychotherapy - "It's not an either/or situation," she says - but she believes that drug treatment is the life-saver. Not to prescribe lithium to a manic depressive, she says, is tantamount to malpractice.

In future, she expects genetic research to have a great impact on the treatment of mental illness, particularly manic depression, which has a strong inherited component. So far, she says, "there are regions on several chromosomes where it is very likely genes [indicative of manic depression] will be found".

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