The Pharmaceutical Journal
Vol 277 No 7411 p140
29 July 2006

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Assessing the risk from antidepressants more
Remembering the man who said that only death and taxes are certain more
How archaeological research is shifting back the origins of agriculture more

Assessing the risk from antidepressants

In the 17 June issue of The Lancet there is a comment from a doctor in Australia on the effect that treatment with selective serotonin-reuptake inhibitors (SSRIs) may have on suicidal tendencies in depressed patients. There have been conflicting claims that SSRIs may reduce suicide rates but increase the risk in some patients early in the course of treatment.

Randomised trials have established that SSRIs are effective against depression in adults but not that they pose a risk of increasing the suicidal tendency. Observations have not found any increased risk specific to SSRIs. Comparisons with amitriptyline, fluoxetine, dosulepin and paroxetine have shown that patients with a history of suicide attempts are more likely to receive an SSRI, with a higher risk within the first nine days of a prescription. However, the risk did not differ between an SSRI and a tricyclic antidepressant.

A recent case control study of suicides and matched controls over the age of 65 found increasing suicide in patients prescribed SSRIs but not other antidepressants in the first 30 days of treatment. The increased risk diminished after 30 days.

Ecological studies have shown a reduction in suicide rates in Scandinavia, Hungary, Australia and the US when SSRI use increased. In Italy and Iceland no such association was found, while in Northern Ireland and the UK it affected individuals over the age of 30 years.

On the available evidence it would seem wise to monitor suicidal ideation in the first two weeks of prescribing an SSRI to a depressed patient, especially an adolescent.

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Remembering the man who said that only death and taxes are certain

Three hundred years after his birth, we remember Benjamin Franklin (1706–90), a polymath who is famously recorded as having remarked in 1789: “In this world nothing can be said to be certain, except death and taxes”. Among many other comments attributed to him are “There never was a good war, or a bad peace” (1783) and “Remember that time is money” (1748) — a rather doubtful proposition that many today may regard with distaste.

As a commentator in Nature for 15 June writes: “If the creation of the American Republic can be taken as a high point of the Enlightenment, then Benjamin Franklin (1706–90) is a central figure.”

Benjamin Franklin was born into a humble family in Boston, Massachusetts, and was self-taught. He became a printer and publisher. Among his most prominent productions was Poor Richard’s Almanac, a highly successful annual full of gentle humour and advice on health.

He had many interactions with medicine and physicians and with matters of health in general. At the same time, he enjoyed a busy life as a natural philosopher and diplomat.

In most of his later life Franklin lived in England and France, first as a colonial representative of Pennsylvania and later as ambassador of the new American Republic, which he helped to found.

This year, London is celebrating Franklin’s 300th anniversary by restoring the house at 36 Craven Street, where he lived for 16 years, as a museum.

Franklin was widely regarded for his famous experiment of flying a kite during a thunderstorm in Philadelphia in 1752, to prove that lightning is composed of flashes of electricity.

As an electrician treating patients with nervous disorders, Franklin was led to conduct wider medical experiments. He advocated inoculation for smallpox. He also studied lead poisoning, first among printers who handled lead type, then among people who consumed cider and wines that had been stored in lead-lined vats.

He advocated exposure to fresh air as an aid to health, and praised the virtues of exercise, particularly swimming. He invented and wore bifocal spectacles. He died at Passy near Paris in 1790.

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How archaeological research is shifting back the origins of agriculture

There are from time to time fierce arguments over the earliest efforts of humans to cultivate food. As a review in Science for 2 June points out, the investigators seeking to date the origins of agriculture have concentrated their attention on findings of wheat, barley and other grains at archaeological sites in the Near East. Their recent conclusion is that annual cereal crops originated about 10,500 years ago.

However, archaeobotanists from Israel and Harvard have come up with the idea that, despite the previous belief that the fig was domesticated in that area some 6,500 years ago, its origin is even further back in human history, making it the first known cultivated plant.

A team of Israeli researchers discovered a store of domestic figs in an ancient dwelling in the Lower Jordan valley. The fruits were carbonised and of a cultivated variety different from the wild fig of the region. Radiocarbon dating of the village where they were unearthed indicated that they were first grown about 11,400 years ago. The age of the first known cultivated plant was therefore increased by some thousand years and it was concluded that humans must have been experimenting with small-scale agriculture hundreds of years before then, as opposed to gathering foodstuffs from the wilderness.

It is believed that the evidence had been ignored for several decades. In the 1970s and 1980s nine dried figs and hundreds of fig drupelets had been found during the excavation of a house in the Neolithic village at Gilgal in the Lower Jordan Valley some 17km north of Jericho, but the archaeologist concerned had died and the fig residues were forgotten for years until it was found after close examination that they belonged to a sterile but soft and edible variety of the fruit. Such a variety would have required human selection and planting.

Humans must have been cultivating figs for several centuries before the wild plants could have undergone the genetic and morphological changes evident in the fruits found at Gilgal. A search for even older cultivars is being undertaken.

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