Prozac Over the Counter?

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Steve Prezant / Corbis

Antidepressants are the most frequently prescribed class of drugs in the U.S., making up about 5% of all prescription medication recorded in outpatient files, according to 2005 figures from the U.S. Centers for Disease Control and Prevention. But if the demand for antidepressants is so high and the pills are so readily dispensed (with the side effects now reasonably well known), would life be easier if antidepressants were just available at the drug store? TIME poses the question to Josephine Johnston, associate for law and bioethics at the nonpartisan research institute, the Hastings Center.

Q: Should antidepressants ever be sold over the counter?

A: I think it's a question that needs a little more clarification. If the question is, "Would providing over-the-counter antidepressants be a way to get needed medicine to clinically depressed individuals?" then you might have one kind of answer to it. And if your question is, "Should antidepressants be available like other recreational drugs, like alcohol?"" then you've got a slightly different question. The trouble, I guess, is there's a lot of concern that if you start providing needed medicine to clinically depressed individuals over the counter, it will pretty quickly become a drug that's used much more like alcohol or some other kind of what we might call recreational drugs.

[But to answer the first question,] I think there's pretty wide consensus that antidepressants work best when they're used in conjunction with other kinds of treatment. If you use antidepressants under the supervision of a physician, you can also talk about how to address some of the [underlying] problems — if the sadness is caused by life events, the death of a loved one or the breakup of a romantic relationship, or if the sadness is caused by a feeling that you don't have control over your work, or by being in an unhappy marriage. Now, if we think antidepressants work best coupled with other therapy, then to provide them over the counter, you're decoupling them from [an important part of the treatment].

[As for the second question, about taking antidepressants recreationally,] my understanding is it's not as if, if you're having a bad day, you can take an antidepressant and feel better for a few hours. The analogy of having a glass of wine on a Friday night, I don't think it really works. You have to be on antidepressants, taking them for a couple weeks, before you start feeling a bit better.

But if you take the libertarian argument, "Why shouldn't people be free to treat their own problems?" then there is no good argument against it. Antidepressants are not that dangerous. And let's put safety aside altogether. Let's say we had a really safe antidepressant, or an antidepressant that's as risky as aspirin or Tylenol. Why shouldn't people be allowed to assist themselves and be in charge or their own lives? In a way when you put it like that it's hard to argue. In some sense — in America, certainly — an argument about autonomy and people making their own choices can end up trumping anything else.

Still, people are concerned about making these things freely available. I think there are some rational concerns, and I think they're about the message we send to people about the best ways to deal with their problems. If you take a painkiller, it's hard to ignore the cause of the pain — if it's something like toothache or appendicitis — because eventually [the condition] is going to get really serious. I guess the worry is that, with antidepressants, you could actually, in the long term, avoid dealing with underlying problems — and that we would do a disservice to our citizens if we gave them that option. [By providing antidepressants for sale over the counter,] you're inadvertently promoting a particular path of dealing with these issues — an easier and cheaper path — so of course people will choose it. How much of a choice is it when you say, "Well you could spend thousands of dollars getting proper treatment, or you could pay $5 on antidepressants. It's up to you!" Some people won't [take that path], but a lot of people will. Then you also risk undermining or taking valuable resources away from more intensive treatment that involves therapy or communication.

Overall I can sort of see both sides, but, in the end, it's hard for me to go completely with free choice. I think the interesting thing about this thought experiment is that it doesn't feel very far-fetched. While you can't buy antidepressants over the counter now, it's pretty easy to get a prescription from your doctor.