Sir : As always, David Healy provides a stimulating point of view in his survey of the fashions of 20th century psychiatry (Psychiatric Bulletin, January 2000, 24, 1-3). But when it comes to antidepressants, a critical viewpoint seems to have been abandoned for anecdotal smears.

We are told that “the complete transformation of personality… was becoming the goal”. Who's goal ? Where is the evidence that any scientist or any company has had this as an objective ? David Healy said that it was “most clearly articulated” in Kramer's (Reference Kramer1993) Listening to Prozac. But as a scientist, he surely cannot authenticate that worthless collection of clinical anecdotes, combined as it was with a naive misconstruction of the role of serotonin. Interestingly, none since Kramer has claimed similar achievements.

More seriously, David Healy reports an American high school massacre, where there were “suggestions that one of the teenagers had an antidepressant in their (sic) blood stream”. Were these suggestions true ? If so, which antidepressant was involved and were any other drugs present ? Was the other teenagar drugfree ? If so, what difference did the unidentified antidepressant make ? And what about the numerous other incidents of this kind in recent years ?

Healy considers none of these critical questions, but quotes without comment a statement by the American Psychiatric Association President which emphasised the dangers of untreated mental illness. So far as one can make out, we are supposed to feel contempt for this statement, all because of ‘suggestions’ as to what might have happened at a particular school. Does he believe there are no risks from untreated mental illness ?

If David Healy wants to argue a case, he should do so on the basis of facts, rather than suggestive smears and half-truths.