The silence of Prozac

Prozac-007In the 1980s, historian of pharmacology Mickey Smith wrote that new blockbuster medicines enter society by a three-step process.

First, a wild popular embrace, driven by overestimation of the drug’s potential, leads to overuse; next, the sudden discovery of “problems” with the drug leads to a backlash; and finally, a state of equilibrium is reached, in which the drug is used judiciously, its real benefits and limits seen clearly at last. Smith called these three stages the “law of the wonder drug.”

I remembered Smith’s formula not long ago, while talking to an old friend on a summer ramble around New York City. The substance of our conversation was that antidepressants—a topic we’d bandied back and forth together for almost 20 years, in various states of using them ourselves and not—had begun to seem quaint. Maybe even a little retro, like lava lamps or tube socks.

This wasn’t to say that antidepressants had become obsolete. We still knew plenty of people who took them, and as of 2011, antidepressants were hanging onto their status as the most-prescribed class of drugs in the USA. Instead, we realised, what we were picking up on was a change of attitude. From their first appearance in the late 1980s until recently, SSRIs were an A-list topic of debate in the culture wars, and the rhetoric, whether pro or con, was red hot. Antidepressants were going to heal, or destroy, the world as we knew it.

Those discussions now feel dated. While antidepressants themselves are here to stay, they just don’t pulse with meaning the way they once did. Like the automobile or the telephone before them, SSRIs are a one-time miracle technology that have since become a familiar—even frumpy—part of the furniture of modern life. At some point recently, they’ve slid into the final act of Mickey Smith’s wonder-drug drama. And in the aftermath of that change, many of the things that people used to say about them have come to sound completely absurd.

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