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Editor-in-Chief Griffith Edwards   Deputy editor Robert West

Regional editors AMERICAS Thomas E Babor AUSTRALASIA Tim Stockwell EUROPE, AFRICA & ASIA Robert West


31st March 1999


Dr Charles Medawar
Social Audit
P.O. Box 1 1 1
London NW1 8XG

Dear Charles

Do antidepressants cause dependence?

I am sorry that I have taken longer with the handling of this piece than I would have wished, but our very efficient Assistant Editor ran into difficulties with one of his chosen referees going to ground. I enclose a photostat of the report received from one referee who has kindly assisted us, and I have also had useful personal advice from the Assistant Editor. The view given to me both by the Assistant Editor and this referee is that this is not probably a piece for a scientific journal.

These views are given to me by two colleagues who. I believe to be both expert and fair-minded, but having heard what they say I thought it proper to read your editorial again very carefully myself and see whether it was possible to take an alternative view. Sometimes scientific journals may do well to publish a provocative piece which critics might see as "journalism", while others might see it as a useful counterbalance to the sometimes rather turgid traditions of science.

Having read and reflected I suppose that I am firstly very aware that you are entering a highly contentious area where vested interests inevitably abound, I am not myself an expert in the area which you are addressing, but as a non-expert I would hope that at the end of reading your editorial I would feel that enough objective evidence had been put before me to allow me to form a view on the rights and wrongs of the contention. I suppose that what I am saying is that I like journalistic liveliness, but I'm still keen on having a scientific regard for evidence and influence. And at the end of reading your piece I felt, sadly, that I really wasn't helped much in my quest for better understanding of where the balance of evidence might really lie. I was still at my starting point which is great uncertainty as to whether we are playing down another possible iatrogenic drug dependence epidemic, or alternatively unfairly attacking the appropriate use of very good drugs. I don't expect you to agree with my editorial judgement that this is not a piece I can take for Addiction, but I hope you will at least feel that that I have thought about the matter rather than just responding reflexly. I think I have to take the advice which colleagues are giving me and cannot see a way around. I very sorry that this is the outcome, specially so when you so generously took up my invitation to write this piece.

Kind regards,
Griffith Edwards


EDITORIAL OFFICE   National Addiction Centre, 4 Windsor Walk, London SE5 8AF, UK

Telephone  +44 171 or (0171) 919 3452/3853  Telefax: 703 5787


Published on behalf of the Society for the Study of Addiction by Carfax Publishing Ltd



Do antidepressants cause dependence?
Manuscript No: NY-1 981270 Referee No. 2

This is not a scientific paper in the usual sense, but something between and discussion and a polemic on whether antidepressants, particularly SSRIs, cause dependence. Charles Medawar is known as a doughty campaigner for this view.

The content partly comprises the history of problems with the benzodiazepines, partly the argument that it all depends on definitions (that, with a much more dispassionate discussion could make an interesting theme,) and a view, without evidence, that return of symptoms on withdrawal of antidepressants is not "relapse" but a withdrawal effect. The same could well be said for the return of high blood pressure on stopping an antihypertensive or, virtually, the return of hypothyroidism on stopping Thyroxin, not to mention hot flushes on stopping HRT.

I do not think that this belongs in a scientific journal. Really it is journalism and doubtless will appear in some form or other in a journalistic setting.




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