Rather, they say, the threat lies more in their use as a substitute for traditional therapy or other solutions that might deal more directly with the person's problems.
Because their side effects are clearly not life-threatening, the new drugs are a convenient "quick fix" for people who may need long-term psychotherapy, agrees New York psychologist Roger P. Greenberg, a critic of the widespread use of Prozac.
The SSRIs have no significant effects on the major organs, and studies show no harm from long-term use. The typical side effects experienced by some people include nausea, insomnia and the jitters.
Newman says one only has to look at a recent trend among veterinarians of giving Prozac to antisocial dogs to see that the traditionally tight restraints on psychotropic medications have been snapped.
"That, in and of itself, suggests the direction we're moving in," he says.
Misbehaving mutts aside, others see no problem with the liberal use of antidepressants if they are thought to be helpful.
"This only gets out of hand if you are forcing people to take things they don't want to take," says Dr. Donald Black, a professor of psychiatry at the University of Iowa. "If these medications have wonderful effects, I personally don't see anything wrong with it. If they are relieving unhappiness or inappropriate behavior, what is wrong with that?"
So sweeping is the drugs' potential that some psychiatrists dislike referring to the SSRIs as "antidepressants."
"That gives you a false idea of what these medications are about," says Dr. Joel Yager, a professor of psychiatry at UCLA. "They are complex drugs that affect brain serotonin. They could just as easily be called anti-compulsivity, anti-obsession or anti-irritability drugs. It's clear all of those psychological characteristics are impacted by SSRIs."
No one is saying that compulsive shopping, premenstrual syndrome, depression and smoking addiction are similar conditions in either cause or treatment. But many disorders such as these appear to involve the neurotransmitters serotonin, and, possibly, dopamine and norepinephrine.
The SSRIs and related compounds increase serotonin, dopamine and norepinephrine. Sufficient quantities of these chemicals must be available between nerve cells to transmit brain messages affecting emotional expression. For example, serotonin is thought to regulate a number of central nervous system functions such as mood and appetite for food and sex.
But in some people, studies show that serotonin is rapidly reabsorbed by the sending cell instead of being suspended in the synapse and eventually binding with the receiving cell. The SSRI drugs halt the reuptake of serotonin.
"If you know the action of the drug, you can make good deductive reasoning on how the new agent might work," says Dr. Robert Gerner, a psychiatrist and expert in psychopharmacology at the West Los Angeles Veterans Affairs Medical Center.
For example, the highly successful treatment of obsessive-compulsive disorder with SSRIs has led to an explosion of research on their use for other types of "compulsive" behaviors.
"There are many other obsessive disorders, like nail biting, hair-pulling, binge eating; compulsive behaviors that are criminalized, such as sexual perversions and exhibitionism, shoplifting, stalkings. There are many ways that obsessions can manifest themselves," Gerner says.
At the University of Iowa, Black has completed a small study giving fluvoxamine to compulsive shoppers. Fluvoxamine is marketed under the name Luvox and is approved in the United States only for treating obsessive-compulsive disorder. But it is widely used as an antidepressant in other countries.
Black gave eight women fluvoxamine for eight weeks and then stopped the treatment. The women received no other counseling or therapy.
"Every single person responded," Black says. "They told me they noticed fewer spontaneous thoughts and fantasies about shopping and spending. They spent less time shopping and spent less money. They were better able to resist their impulses."
Similarly, UCLA's Yager has used Prozac to help women with anorexia nervosa who also exercise compulsively. According to a recent study, women who had restored their weight while hospitalized and then began taking Prozac were much more likely to maintain their weight one year later, he says.
"I had one patient who exercised compulsively; she did the stair-climber hours a day. Two months after starting Prozac, the entire syndrome evaporated. She has put on weight and has been fine," he says.
Prozac may soon be approved for bulimia. And while many doctors who treat eating disorders are also prescribing the SSRIs, "This needs to be studied in a much more systematic way now," Yager says.
More research is clearly needed to show which antidepressants work best for particular disorders.