Depression and obesity treatments are life saving

To the editor

I was disappointed to read in your September 2002 issue a classification of antidepressants and antiobesity drugs as “lifestyle drugs”¹. Depression is not a lifestyle; it is a severe medical disorder that has been recognized as such since antiquity². Melancholia (black bile in Greek) is a subtype of depression that was named by Hippocrates 2,500 years ago. It is the only disease category to have survived in its original name from the Hippocratic classification of disease based on the four humors². Moreover, people die of depression, and do so in great numbers. Depression is the major cause of suicide. According to recently released information from the Centers for Disease Control and Prevention (CDC), in the year 2000 suicide was the 11th highest cause of death in the United States³. When causes of death are examined by age group, the importance of suicide as a cause of death is self-evident (Table 1)³. Moreover, depression is an independent risk factor for heart disease, which is the leading cause of mortality in the US. In this context, antidepressant treatment is not a lifestyle option, it is a life-saving necessity.

Table 1 CDC data on suicide in the U.S.

Obesity is also a key contributor to morbidity and mortality and can have a profound negative impact on health and life expectancy. Obesity is associated with diabetes, heart disease, pulmonary disorders, bone and joint disease, reproductive diseases, cancer and gallstones. Moreover, modern research has recognized a strong genetic component to obesity.

It is simply unacceptable to label as “lifestyle drugs” treatments for diseases of gene–environment interactions, such as depression and obesity, which are serious public health problems worldwide.

We reply—We certainly agree that depression and obesity are potentially life-threatening conditions, and regret the characterization of these in our news story as mere “lifestyles”. However, we stand by the main part of the piece, which focused not only on these conditions, but on other afflictions currently the focus of pharmaceutical development, including hair loss, age-associated wrinkling, graying hair and smoking cessation. To some extent, whether these afflictions are life “threatening” or life “style” is a matter of degree, which will vary widely between individuals. Finally, we would like to make the point that many of the “lifestyle drugs” described are widely advertised to the public, which consequently may be tempted to obtain and take these drugs even in the absence of a life-threatening condition.