"Better than Well" Variability and Dr. Healy's Let Them Eat Prozac

To follow up on Chris' well written post on Listening to Prozac, I thought I'd introduce another author who's written on the subject of antidepressants. A simplistic view of Dr. David Healy is that his opinions are somewhere in between Dr. Breggin and Dr. Kramer. Like Dr. Breggin, he's extremely outspoken against the practices of the pharmaceutical industry with regards to antidepressants, even losing a job to his opinions on Prozac's suidicial risk (see http://www.pharmapolitics.com). Unlike Dr. Breggin and more towards Dr. Kramer's outlook, he recognizes the usefulness of antidepressants in psychiatry and even presents an interesting arguement for their Over the Counter status (see The Antidepressant Era and Let Them Eat Prozac).

In terms of Healy's relationship to the idea of cosmetic pharmacology and the better than well effect, in his book Let Them Eat Prozac, he shares the result of a very interesting (albeit small) experiment he conducted at his hospital in the UK (Primary Care Psychiatry, 2000). Utilizing 19 healthy hospital employees, including psychiatrists, nurses, and administrators, Healy performed a 2 week cross over study with the SSRI Zoloft and the SNRI (Selective Noradrenaline Re-uptake inhibitor) Reboxetine. The findings? There was indeed a "better than well" effect, meaning these "normal" individuals felt good on drugs that are usually reserved for depressed individuals. The kicker comes in when we see that this effect was split down the middle: half the group like Zoloft and half the group liked Reboxetine. While the unliked drug usually only resulted in expected side effects, there were a couple individuals who had a negative response to either drug. It made their mood worse.

The results of Healy's small experiment speak to 2 very important ideas. The first is a rather old idea that is utilized by psychiatrists today: individual temperment can often predict response to an antidepressant with a particular mechanism (for more information on this, do a pubmed search for Joyce PR). While the exact details of this phenomenon have yet to be worked out (what types of people will respond to which drugs?), even non-depressed individuals might have specific responses to seroternergic or noradrenergic drugs. The second idea is that for any given drug, it appears there are always going to be three main groups of people: 1 group who responds well to the drug, 1 group who doesn't respond, and 1 group who responds adversely.