Introduction

There are typically three parties to the act of taking any psychotropic drug: the taker, the prescriber and the company that produces and markets the drug. All three are bound up by the history of our attitudes to psychological problems, to psychotropic drug-taking and to the processes of industrialisation that take place both within the pharmaceutical industry and within medicine. All three are also shaped by changing attitudes in society at large, one of which involves an increasing awareness of the rights of individuals, included in which is a right to information about treatments they may be given.

These forces have conspired in recent years to bring about the production of handbooks about drugs that cover their mode of action, their potential benefits and their possible side effects. However, such handbooks consist mostly of lists of drugs with bold statements of reputed modes of action and comprehensive lists of side effects. These give little flavour of how the drugs concerned may interfere with individual functioning or impinge on individual well-being.

One of the aims of this book, in contrast to these others, is to produce a text that makes the issues live. To this end, there is a lot of detail about the history of different drugs. On the question of what the various drugs do, both current thinking and current confusions are outlined. Too much certainty is, I believe, the enemy of both progress and science. And apparent academic certainty tends to invalidate the perceptions of a drug taker – who is actually one of the individuals best placed to contribute to the further development of psychopharmacology.

I also include an attempt to assess the influence of the pharmaceutical industry on the perceptions of both clinicians and patients.

More importantly, rather than simply give a list of benefits and side effects, I attempt to give a fuller description of what the experience of the side effects may be like and how these impinge on normal living. To try to put some flesh on the bare bones of a list of side effects means that I have compromised between being comprehensive and being significant. Readers should be aware that this book does not include every known side effect. It does not include precise figures as to the frequency of each side effect. It does not include all known interactions with other compounds. What it does include are the reactions and interactions that occur regularly, and the book attempts to give some feel for how important or otherwise these are.

What emerges, nevertheless, is a list of side effects that, in many respects, is rather fearsome – to add to a set of motives on the part of both prescribers and the pharmaceutical industry that are often venal. Many of my colleagues wonder whether taking this course of action is advisable. I have a number of reasons for thinking it is.

CONSUMERS AND COMPLIANCE