Biomedical Engineering Reference
In-Depth Information
spheres of philosophy, psychology and sociology (Crossley 2003)? Or does
it rather offer us a more nuanced account of mental illness and suffering,
emphasizing the importance, not only of the brain, but also of the lived
body? This is a fascinating task for future research on the SSRI revolution,
which I hope to be able to engage in myself.
Notes
1 In 1990 the prescription (sale) rate was 8 DDD (daily defi ned doses per 1,000
persons each day). In 2000 it was 48 DDD, and in 2004 (statistics available to
30/06/2004) it was 62 DDD (source: www.apoteket.se). It is, of course, hard
to know how many of these daily defi ned doses are actually consumed by the
patients. The statistics end when the drugs leave the pharmacy.
2 According to the Swedish Council on Technology Assessment in Health Care,
the lifetime incidence of depression is 17-18 per cent (SBU 2004: 73). Given the
fact that antidepressants are not only prescribed for depression, but also for a
variety of anxiety disorders, 20 per cent of the population could very well be an
underestimation. Although I have not carried out systematic comparisons with
other countries, it should be pointed out that the Swedish development is by no
means unique, possibly not even extreme. In the USA, the cost of antidepressive
drugs per citizen is twice as high as in Sweden (statistics from 2001 found at
www.nihcm.org and at www.apotektet.se). The total cost of antidepressive
medication in the USA in 2001 was 12.5 billion dollars, to be compared with
about 0.2 billion dollars in Sweden. The USA has about 293 million citizens;
Sweden has about nine million citizens.
3 See Andersson (2003) and Healy (2004) in which the marketing and research
strategies of pharmaceutical companies selling antidepressants are critically
evaluated and discussed.
4 For the development of antidepressive pharmaceuticals from the time of
the Second World War until today, see David Healy's excellent topic
The
Antidepressant Era
(1997).
5 Indeed, the current expert opinion, based on evaluation of existing clinical trials,
is that SSRIs are not more effi cient than tricyclics in the treatment of depression.
In the case of severe depression, tricyclics even seem to be better than SSRIs
(SBU 2004: 191ff.).
6 See www.apoteket.se and www.nihcm.org. In the future, we will probably
see new kinds of mood-affecting drugs infl uencing the levels, not only of
serotonin, but also of noradrenaline and other neurotransmitters in the brain.
The knowledge of different kinds of receptors for the same substance (there
appears to be at least 14 different kinds of receptors for serotonin, for instance)
might also lead to new breakthroughs in drug development. Although the big
rise in prescriptions of antidepressants in Sweden and other countries has come
about through SSRIs, experts are in no way convinced that lack of serotonin is
the “magic target” of depression, in any way similar to, for instance, the lack
of insulin in diabetes. Matters are far more complex; see, for instance, Healy
(1997) and Whybrow (1997).
7 As the title of Peter Kramer's infl uential topic from 1994 urges us to do.
8 In this chapter, the terms “illness” and “disease” are used in accordance with
the standard distinction made in the fi elds of medical philosophy, psychology
and sociology between personal experience, on the one hand, and biological
processes, on the other.
