we'll vote on politics, not pills

Being manic-depressive, I find myself reacting more strongly than I had anticipated to speculation in the media, informed almost totally by that in the blogosphere (as Platform 10's David Skelton observes), that Gordon Brown may be taking antidepressants.

The rumour has its genesis in a blog by John Ward, in a piece called "Establishment 'colluding in plight of sick man Brown'". It's gone through various columnists like John Barr's best beef, and culminated in Andrew Marr asking the Prime Minister, on his Sunday morning political show, if he was one of the many British people who "use prescription painkillers and pills to get through":




Ward states that "Before the arrival of Prozac derivatives, [MAOIs] were the first line of attack when dealing with severely depressed patients". I started training as a psychiatric nurse in Scotland shortly before Prozac was introduced, and MAOIs were very much a last resort then as now, only to be used when tricyclic antidepressants such as amittryptilene or lofepramine or, if necessary, antipsychotic medication had failed. Also, I can't find any mention in the prescriber's "bible", the British National Formulary, of MAOIs being used to treat Obsessive Compulsive Disorder, another of Ward's claims.

MAOI stands for monoamine oxidase inhibitor. Monoamine oxidase is an enzyme found in various parts of the body that breaks down tyramine, a compound derived form an amino acid that acts to release neurotransmitters such as dopamine, adrenaline and noradrenaline ( a longer-acting version of adrenaline). So if production of monoamine oxidase is damped down, tyramine can accumulate in the body, facilitating the production of the above neurotransmitters, which somatimes can help somebody whose depression has been otherwise treatment-resistant to work towards recovery.


The reason MAOIs are prescribed with caution is that when somebody takes them along with food high in tyramine (remembering that there already high tyramine levels in the body) a hypertensive (high-blood-pressure) crisis can arise, which could lead to burst blood vessels - for example in the brain, causing a stroke. So foods high in tyramine must be avoided - the mnemonic we learnt was "nothing pickled, processed, fermented, salted or spoiled", although a whole host of foods must be avoided, not all of which fall easily under any mnemonic. This is what started the rumour - when a "senior civil servant" mentioned "the latest nonsense - a huge list of things [Brown] can't eat or drink because of the drugs he's on...most importantly, cheese and Chianti". Those are certainly foods I would avoid if I were on MAOIs, but also if I had, say, severe heartburn.

As Marr observed, Americans know all about their President's medical history - and, I have to say, when applying for a job I mention my illness in the main part of the form and not just the equal opportunities bit (so it's frustrating when I mention it and interview panels are surprised, indicating they haven't read past the front page of the form). But we don't have such a system here, and importing it would set the law of unintended consequences in motion just as surely as exporting the NHS to the US.

Revd Chad Varah, founder of the Samaritans, wrote in Samaritans in the 80s that if depression approaching the point of suicidality were a bar to political power, the House of Commons' front benches would be somewhat emptier. Marr himself wrote of beleaguered Conservative Prime Minister Anthony Eden - of Suez Crisis fame - in 2007 (the year before Blair finally gave way to Brown): "By the time he finally got the top job halfway through the decade, he was physically depleted...like a racehorse who had been trained to win the Derby in 1938 but was not let out of the starting stalls until 1955".

Whether or not Brown is on antidepressants, what he is experiencing, sometimes at the hands of those around him, may be a consequence of the medicalisation of problems that do not fall within the sphere of medicine. Sometimes we all, as flawed human beings, experience problems that, as part of our personalities and not of a pathological process, take us to places we did no intend to go. Take Lord Peter Mandelson - he gave a rousing and even excellent speech at the Labour Party Conference yesterday, but that's the point: when its all about Peter, Peter presents no problems. But when he feels the attention draining away, he acts to bring the spotlight back upon himself, and seems not to care whether he is cast in a positive or negative light.

Is Gordon Brown fit to run the country? In my opinion, no. Not because of what may or may not be happening with his brain chemistry, but because of the wholesale dismal failure across the Labour Party in 12 years of misgovernment. That's what I'll be highlighting in the time before we eventually get a general election, not a poisoned chalice of an agenda which could lead our opponents to rumble about discrimination on the grounds of disability should the antidepressant angle play a substantial part in a Conservative victory.

And what made me sit up straight was that it was that most hard-boiled of political commentators, Iain Dale, who teased out the pertinent point amid the tough days to come: If Brown is ill he deserves our compassion, not our insults.