An article in the February 4 issue reported on an example of the dangers of polarized positions: the Colorado Psychiatric Society versus Peter Breggin, M.D., and the Citizens Commission on Human Rights regarding psychotropic medication. There is need for a more reasonable middle ground.

Certainly antidepressants have helped thousands of patients, and the number of effective drugs currently available increases the chances that careful practitioners can help their depressed patients. However, it is also true that on occasion these drugs activate latent manic/psychotic reactions (JAMA 280:133, 1998). The literature is clear on this point, and the potential for these reactions is noted for every antidepressant compound listed in the Physicians’ Desk Reference. The contribution of antidepressant use to psychotic/manic behavior in individual instances can be assessed only by a detailed knowledge of the case. However, clinicians can be alert to this potential problem by obtaining a careful family history and by following the course of patients at risk for manic/psychotic reactions very carefully. The extreme positions represented by the article cited are neither accurate nor clinically helpful.

Malcolm Bowers Jr., M.D.

Adrian Preda, M.D.

New Haven, Conn.