Conspiracy of consensus.
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Biomedical subjects
Publications and source records attributed to David Healy.
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In 1998, the first Pioneers in Psychopharmacology Awards were presented at the XXIst CINP Meeting in Glasgow to Pierre Deniker, Joel Elkes and Heinz Lehmann. These three individuals had distinguished themselves and Psychopharmacology not only by the quality of their work but also by their ability to persuade others of the importance of the new field that was opening up (Healy, 1998). At the XXIInd CINP Meeting in Brussels in July 2000, Paul Janssen, Mogens Schou and Alec Coppen became the second group to receive such awards for distinguished achievement.
In pursuing the history of any field, even one in which many of the main exponents are still alive, it can be very difficult to establish facts and priorities. Detailed scrutiny of the events leading to the recognition of the antidepressant effects of iproniazid, in which Nathan Kline was involved, may fail to establish the exact sequence of events or the sources of inspiration for a discovery (Healy, 1997). Quite apart from the 'facts' behind the antidepressant story, Kline's role in the story beautifully illustrates one of the sayings of Francis Galton, to the effect that in history the driving force may not lie with the first discoverer of a new scientific fact, but rather with the individual who was the first to persuade the world of the importance of a particular discovery. This maxim applies with some force to the three individuals who have been honoured by the CINP in 1998 for their pioneering roles in psychopharmacology - Pierre Deniker, Joel Elkes and Heinz Lehmann whose contributions to the field have included original research and also key initiatives to capture the central ground of academic and public opinion for the new science. They have been science makers rather than just scientists.
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BACKGROUND: There has been a long-standing controversy about the possibility that selective serotonin reuptake inhibitor (SSRI) antidepressants might induce suicidality in some patients. METHODS: Starting from the clinical studies that gave rise to this issue, this paper reviews an unselected cohort of randomized clinical trials (RCTs), a series of meta-analyses undertaken to investigate aspects of the problem, studies in recurrent brief depressive disorders, epidemiological studies and healthy volunteer studies using SSRIs to shed light on this issue. RESULTS: The original clinical studies produced evidence of a dose-dependent link, present on a challenge, dechallenge and rechallenge basis, between SSRIs and both agitation and suicidality. Meta-analyses of RCTs conducted around this time indicate that SSRIs may reduce suicidal ideation in some patients. These same RCTs, however, yield an excess of suicides and suicide attempts on active treatments compared with placebos. This excess also appears in the best-controlled epidemiological studies. Finally, healthy volunteer studies give indications that SSRIs may induce agitation and suicidality in some individuals. CONCLUSIONS: The data reviewed here, which indicate a possible doubling of the relative risk of both suicides and suicide attempts on SSRIs compared with older antidepressants or non-treatment, make it difficult to sustain a null hypothesis, i.e. that SSRIs do not cause problems in some individuals to whom they are given. Further studies or further access to data are indicated to establish the magnitude of any risk and the characteristics of patients who may be most at risk.