If it is demonstrated that people would generally opt for a chemical solution to their everyday problems, is that necessarily bad? In fact, some do "self-medicate." The extreme examples are those individuals who abuse drugs like crack cocaine and heroin. These people are seen as taking the easy way out, wasting away their lives while trying to escape from reality. To some extent this may be true. The initial reason may have been one similar to escape, entertainment, or even curiosity. However use of the drug is more than likely maintained by physical addiction. These drugs produce withdrawal symptoms that make it very difficult to discontinue use. This is not only a main reason why people are on the drug, but also a reason why it is perceived as bad (Edwards, 1982). One addicting drug currently legal is nicotine. People continue to smoke cigarettes while knowing the health risks. The nicotine makes them feel good, and without cigarettes, a smoker will go though withdrawal. This is much easier to solve than a withdrawal from cocaine, since cigarettes are cheap and easy to purchase. There are laws prohibiting smoking in many places, but that is not nearly as restrictive as outlawing nicotine.

If it was possible to provide the nicotine without the hazards of smoking, would people switch to this less risky method? In fact, nicotine patches are now available with a prescription. People do use them to quit smoking. That also means quitting nicotine as well. The final goal is not only to end their health risks, but end their dependency on the drug.

Does fluoxetine pass the dependency test? Going off fluoxetine does not cause any major physical withdrawal symptoms. However, after several months a relapse may occur. The patient may often request to go back on the medication, to return to the desired medicated state. This may sound like a dependency. The patients seem to need fluoxetine to maintain their condition.

What are the differences between fluoxetine and a narcotic such as opium? Both may be perceived to cause an uplift in mood. First is the mechanism in which the drugs act. Morphine is similar in chemical structure to the peptide neurotransmitters met-encephalon and leu-encephalon. Morphine is able to react with the same receptors as these and produce the same effects as these internally synthesized chemicals, such as relief from pain. (Kalat, 1992).

Fluoxetine does not mimic serotonin, it increases the lifespan of the active neurotransmitter at the synapse. Thus the user may be dependent not on the drug, but the effect of the elevated serotonin activity. There is considerable evidence that patients with depression have an alteration in their serotonergic neuronal system (Owens, 1994). If the pharmaceutical restores the neuronal system to normal functioning, this may be an altered state from what the patient is used to, but not a deviation from the norm. Is the patient still considered to be dependent on fluoxetine? Perhaps so, but only to maintain the serotonin activity found in "normal" humans without major depression.

The fact that Fluoxetine requires long term use may change the perception of its effects. A drug that is used as a one time cure may appear to have an advantage since it has full effect when it is used once and is no longer required. Drugs like Fluoxetine act not as agents if a short term "fix" but as a constant regulator. This chemical maintenance may still be perceived as negative. However this same argument may lead to criticism of other forms of external or artificial maintenance. Diabetics require an outside source of insulin, kidney dialysis is needed for those with renal failure, and patients with major coronary problems use pacemakers and even artificial hearts. Is it this replacement of "natural" functioning with artificial maintenance that is seen as bad?

The argument that makes the strongest tie between fluoxetine and illicit drugs may be Breggin's (1994) position that fluoxetine acts as a stimulant. Breggin (1994) believes that the side effect profile of fluoxetine matches that of stimulants, which includes; insomnia, nightmares, agitation, anxiety and nervousness. The effects of headache, nervousness, insomnia and tremor are indistinguishable from those associated with amphetamines or cocaine. A biological basis for Breggin's theory may be present. Like fluoxetine, amphetamines and cocaine also produce the effect of an elevated serotonin level (Kruk, 1991). This is only one of the effects that cocaine and amphetamines have on neurotransmitters.