1 Selective serotonin reuptake inhibitors (SSRI) – sales, withdrawal ...

2. Abstract
Psychotropic drug use has increased in all European countries, also in Denmark, due to the
introduction of the so-called selective serotonin reuptake inhibitors (SSRIs) in the late 1980s and
changed prescription habits. Further, patients have raised the suspicion that the SSRIs could cause
dependence. This suspicion has, however been rejected by marketing authorisation holders and by
regulatory agencies, the latter being responsible for guarding public safety in relation to medicines
The overall aim of this PhD thesis was to explore the life-cycle of the SSRIs and compare it with
benzodiazepines with respect to use and dependence. This was investigated in 3 studies. In the first
study, we explored the possible causes for the sales of psychotropic medicines in Denmark. In the
second study we explored the rationale for claiming that benzodiazepines cause dependence while
selective serotonin reuptake inhibitors (SSRIs) do not. The third study was a documentary study
describing actions and statements of the regulatory agencies in UK, USA, England and Denmark.
We explored the communications from drug agencies to the public saying that benzodiazepines
cause dependence whereas selective serotonin reuptake inhibitors (SSRIs) cause a withdrawal
syndrome because the phraseology of the communications might explain why benzodiazepines are
viewed as being addictive in contrast to SSRIs.
The first study showed that the sales of psychotropic drugs has fluctuated widely over a 37-year
period. We believe that the decline in sales of benzodiazepines was primarily due to the recognition
that they cause serious dependency and by initiatives at a national level to curb their use, and that
the recent steep increase in sales of SSRIs is a direct consequence of marketing pressures, as the
effect of the SSRIs is overestimated.
The second study showed the withdrawal reactions to SSRIs were very similar to those for
benzodiazepines. It therefore makes no sense to describe only the latter as dependence symptoms.
denied that the reactions indicated SSRI dependence. Drug regulators underestimated in both cases
the frequency and severity of the symptoms. The third study showed that in the perspective of the
precautionary principle it could be understood as if the drug agencies have refused to acknowledge
that SSRIs can cause dependence, with reference to the diagnostic disease manuals ICD-10 and
DSM-IV, and minimised the problem with regard to the severity and the number of people affected.
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