Showing posts with label Prozac. Show all posts
Showing posts with label Prozac. Show all posts

Monday, May 2, 2011

Manipulating morals: scientists target drugs that improve behavior

Researchers say morality treatments could be used instead of prison and might even help humanity tackle global issues  -  Progress, Big Brother or just creepy…?

Prozac

Existing drugs such as Prozac are already known to affect moral behaviour, but scientists predict that advances may allow more sophisticated manipulations. Photograph: Scott Camazine/Alamy

A pill to enhance moral behaviour, a treatment for racist thoughts, a therapy to increase your empathy for people in other countries - these may sound like the stuff of science fiction but with medicine getting closer to altering our moral state, society should be preparing for the consequences, according to a book that reviews scientific developments in the field.

Drugs such as Prozac that alter a patient's mental state already have an impact on moral behaviour, but scientists predict that future medical advances may allow much more sophisticated manipulations.

The field is in its infancy, but "it's very far from being science fiction", said Dr Guy Kahane, deputy director of the Oxford Centre for Neuroethics and a Wellcome Trust biomedical ethics award winner.

"Science has ignored the question of moral improvement so far, but it is now becoming a big debate," he said. "There is already a growing body of research you can describe in these terms. Studies show that certain drugs affect the ways people respond to moral dilemmas by increasing their sense of empathy, group affiliation and by reducing aggression."

Researchers have become very interested in developing biomedical technologies capable of intervening in the biological processes that affect moral behaviour and moral thinking, according to Dr Tom Douglas, a Wellcome Trust research fellow at Oxford University's Uehiro Centre. "It is a very hot area of scientific study right now."

He is co-author of Enhancing Human Capacities, published on Monday, which includes a chapter on moral enhancement.

Drugs that affect our moral thinking and behaviour already exist, but we tend not to think of them in that way. [Prozac] lowers aggression and bitterness against environment and so could be said to make people more agreeable. Or Oxytocin, the so-called love hormone ... increases feelings of social bonding and empathy while reducing anxiety," he said.

"Scientists will develop more of these drugs and create new ways of taking drugs we already know about. We can already, for example, take prescribed doses of Oxytocin as a nasal spray," he said.

But would pharmacologically-induced altruism, for example, amount to genuine moral behaviour? Guy Kahane, deputy director of the Oxford Centre for Neuroethics and a Wellcome Trust biomedical ethics award winner, said: "We can change people's emotional responses but quite whether that improves their moral behaviour is not something science can answer."

He also admitted that it was unlikely people would "rush to take a pill that would make them morally better.

"Becoming more trusting, nicer, less aggressive and less violent can make you more vulnerable to exploitation," he said. "On the other hand, it could improve your relationships or help your career."

Kahane does not advocate putting morality drugs in the water supply, but he suggests that if administered widely they might help humanity to tackle global issues.

"Relating to the plight of people on other side of the world or of future generations is not in our nature," he said. "This new body of drugs could make possible feelings of global affiliation and of abstract empathy for future generations."

Ruud ter Meulen, chair in ethics in medicine and director of the centre for ethics in medicine at the University of Bristol, warned that while some drugs can improve moral behaviour, other drugs - and sometimes the same ones - can have the opposite effect.

"While Oxytocin makes you more likely to trust and co-operate with others in your social group, it reduces empathy for those outside the group," Meulen said.

The use of deep brain stimulation, used to help those with Parkinson's disease, has had unintended consequences, leading to cases where patients begin stealing from shops and even becoming sexually aggressive, he added.

"Basic moral behaviour is to be helpful to others, feel responsible to others, have a sense of solidarity and sense of justice," he said. "I'm not sure that drugs can ever achieve this. But there's no question that they can make us more likeable, more social, less aggressive, more open attitude to other people," he said.

Meulen also suggested that moral-enhancement drugs might be used in the criminal justice system. "These drugs will be more effective in prevention and cure than prison," he said.

By Amelia Hill - guardian.co.uk, Monday 4 April 2011 16.23 BST

Article history

Monday, May 11, 2009

Newer Antidepressants Not Always Better

New antidepressants might be no more effective than the best existing drugs, according to two new systematic reviews that compared 12 commonly used medications.

"Patients are usually enc
ouraged to take the newest medication," said lead author Andrea Cipriani, M.D., of the University of Verona, in Italy. "But it's better to have an old treatment that has been proved with many patients and many years in the market."

The
reviews suggest that sertraline sold under the brand name
 Zoloft since 1991 could be the best initial choice of antidepressant in people with acute major depression. The generic formulation produced the best balance of effectiveness, tolerability and purchase price, the authors say.

Patients also did well on one of the newest antidepressants, escitalopram (
Lexapro), but it is not yet available in lower-cost generic form. The authors note that comprehensive economic studies are necessary to evaluate overall cost-effectiveness of various treatments.

Cipriani said that the review recommendations are for new episodes of depression. "If a patient is taking another drug and doing well, we are not saying he has to change."

The reviews appear in the most
recent issue of The Cochrane
Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Depression is the fourth-leading cause of disease burden worldwide and antidepressant drugs are now the mainstay of treatment for moderate to severe cases. The aim of the two reviews was to compare the benefits and side effects of sertraline and escitalopram, respectively, with those of other antidepressants during the first six to 12 weeks of treatment.

Cipriani noted that all of the included studies compared one drug against another not to a placebo so the results reveal not the absolute effect, but rather the relative advantages and disadvantages of various medications.

In addition, these reviews rely on summary data from each study, rather than individual patient data. Future studies that go into greater detail can help identify the best medications for various subgroups of patients such as men vs. women, teens vs. adults and so on.


For sertraline, the reviewers included 59 randomized controlled trials totaling about 10,000 participants. Sertraline proved more effective than fluoxetine (Prozac), but less effective than mirtazapine (Remeron). In terms of side effects, bupropion (Wellbutrin) was easier to tolerate than sertraline, while the latter outscored amitriptyline (Elavil), imipramine (Tofranil), paroxetine (Paxil) and mirtazapine (Remeron).

For escitalopram, the reviewers included 22 randomized controlled trials totaling about 4,000 participants. Few statistically significant differences appeared in this review, although escitalopram was more effective than citalopram (Celexa) and fluoxetine (Prozac) and had fewer side effects than duloxetine (Cymbalta). The drug manufacturer sponsored most of the studies in this review, so there may be biases in favor of escitalopram.

Rather than seeking genuine advances in treatment, the
review authors say, some pharmaceutical companies seem to be introducing close chemical cousins of generic medications. By gaining patent protection for the "new" drug, a company can market it as a higher-priced brand name product.

Sponsorship bias is a recurring concern in trials of virtually all new medications. In the Cochrane reviews themselves, one of the co-authors has received research funds and speaking fees from the companies Asahi Kasei, Astellas, Dai-Nippon Sumitomo, Eisai, Eli Lilly, GlaxoSmithKline, Janssen, Kyowa Hakko, Meiji, Nikken Kagaku, Organon, Otsuka, Pfizer and Yoshitomi. The Japanese Ministry of Education, Science and Technology, and the Japanese Ministry of Health, Labour and Welfare have also funded some of his research.

However, the co-authors of these Cochrane reviews also published a recent study in The Lancet that was free of any potential funding bias. The study also used a more complex statistical method to analyze data from 117 randomized controlled trials involving 25,928 participants.

The findings support the Cochrane reviews, Cipriani said, with sertraline and escitalopram ranking as the best treatments.


"Such findings have enormous implications," said Sagar Parikh, M.D., of the University of Toronto, in a commentary published along with The Lancet study. "For the clinician, prudent engagement of the patient in treatment ideally involves giving the patient a choice.… A new gold standard of reliable information has been compiled for patients to review."

In early studies, new medical treatments are typically compared to sham treatments. Once the effectiveness of certain approaches is well established, new options must be judged against the best existing treatments.

Cipriani argued that this time has come for antidepressants, and that sertraline is the drug to beat. "We need new treatments in psychiatry, but they have to be proved better than other treatments," he said. "We should be comparing new drugs to the best available existing drugs."

The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions.

Cipriani A, La Ferla, et al. Setraline versus other antidepressive agents for depression. The Cochrane Database of Systematic Reviews 2009, Issue 2.

Cipriani A, Santilli C, et al. Escitalopram versus other antidepressive agents for depression. The Cochrane Database of Systematic Reviews 2009, Issue 2.


Source: Health Behavior News Service