Jagged Little Pills

[Guest guest]

March 19, 2006

Op-Ed Contributor

NYT

Jagged Little Pills

By LAUREN SLATER

Somerville, Mass.

OUR poor pills. I am not sure whether they betray us or we betray them.

When it comes to psychotropics, we are all men easily swept off our

feet, composing bad love poems, willing to wine and dine at sky-high

prices, only to break off our engagement with a stamp and a pout once we

see our bride-to-be without her makeup.

The new Ambien uproar - our supposedly safe sleeping pills have been

reported to cause amnesia and sleep-disordered states - is just one more

example of a pattern so pervasive in the brief and labile history of

psychiatric medication that I'm surprised we haven't yet created

chemical cures for those mourning their chemical cures.

Our psychotropics seem to go through fairly predictable 20-year cycles,

so eerily consistent that at this point we should be able to pinpoint in

precisely what year our newest superstar will fumble. What's odd is that

we don't. Rather, each time the negative side effects come into view, we

act slapped, surprised, as though this were the strangest thing in the

world.

One needn't look far to see the footprints. In 1951 the first

psychiatric medication was accidentally discovered, concocted from an

antihistamine intended to clear clogged nasal passages, and shortly

thereafter observed to have a sweetly sedating effect on the tumultuous

minds of the insane. Chlorpromazine was its name, and it seemed to be a

sort of psychotropic Drano, clearing up the stuffed psyches of

schizophrenics. Promoted with great fanfare, it was not until later that

its ominous underbelly began to manifest in a series of movement

disorders called tardive dyskinesia.

Soon after that, the first antidepressant was produced. Before it killed

a few famous folks, iproniazid was heralded by the Manhattan masses as a

miracle drug and a " psychic energizer. " Of course it didn't take long

for it to fall flat on its brand-new face, spiking the blood pressure of

its imbibers, some of whom died miserable deaths. Iproniazid was

promptly sent to the corner with a dunce hat, and it sat there for the

next 50 years or so.

Psychotropics rise to prominence in ways that are distressingly

familiar, with pixie dust and promise, making their way into the news

media and onto the covers of national magazines. In the 1950's, for

instance, Miltown was a superstar, until it was discovered to make mad

hatters out of people trying to withdraw. And then, of course, there was

Prozac. In 1990, it floated serene and bulbous on the cover of Newsweek,

in a sky of Crayola blue. Today that same friendly pill is branded with

a black box stating that Prozac can cause suicidal ideation.

Why the 20-year cycle? Perhaps it has something to do with the fact that

a new drug has patent protection for about that length of time, after

which it loses much of its profit power. Maybe drug companies are highly

motivated to quash consumer complaints only until their patents expire.

Or perhaps, more simply, 20 years is about how long it takes for nasty

side effects to manifest. I like the idea that human hope has a

half-life of about 10 years and is fully excreted in two decades, just

as the chemical substrates of passion seem to last about four years,

which is the point at which anthropologists have observed divorces begin

to occur.

While it's fun to speculate on what the 20-year time frame means, it's

not fun to find that your best friend, your chemical crutch, has

suddenly turned toxic. Given the grave disappointment that often

accompanies this turn of events, it behooves us to find a way to discuss

our drugs in a language marinated in neither mania nor despair. As long

as we approach our chemical cures with this all-or-nothing view, we will

be vulnerable to excess and our pills trapped in a plot where there are

only heroes and villains.

Medicines are a product of fallible human science and have no place as

fashion or fad. They demand a nuanced conversation and continuous

caution. If we are smart, we will see that disappointment is built into

each drug's birth and is inevitable in its lifetime.

One might be tempted to blame the pharmaceutical companies for our

breathless approach to new drugs. Advertising sleep medications with

butterflies alighting on upturned palms certainly gives the impression

of safety, and more. But for how long can we rail against the

predictable profit motive of advertisers?

It is time to say, buyer beware. Every questing singleton on Match.com

understands that profiles are gussied up in the hope of sales. The

nature of the game is such that no one writes " loveable, calm swm with

occasional halitosis and some anger management issues. " And when these

traits inevitably emerge, we don't blame Match.com.

It is up to us, the consumers, to disregard the hype that too often

infuses pharmacological findings - to know that the pill we cradle in

our palm may ease our pain, but will just as surely take its toll.

Slater is the 2006 guest editor of " Best American Essays " and the

author of " Opening Skinner's Box: Great Psychological Experiments of the

20th Century. "

Regards,

" Every science touches art at some points while

every art has its scientific side; the worst man

of science is he who is never an artist, and the

worst artist is he who is never a man of science. "

[Armand Trousseau]