We read with interest the recent article by Tan et al. [1], claiming that the use of psychotropic drugs causes changes in colonic architecture. We strongly disagree with this concept, which may lead to inappropriate modifications of therapeutic schedules in patients needing such pharmacologic treatments, and the reasons are presented below. First, the authors relied on subjective descriptions by several different endoscopists, definitions such as ‘‘megacolon,’’ or ‘‘capacious,’’ ‘‘redundant,’’ or ‘‘featureless’’ colon. These descriptions are difficult to objectivize and a barium enema is needed to actually demonstrate an excess length, an increased diameter, or the loss of haustration in the large bowel. Second, as per authors’ own admission, most of their patients were constipated. Constipation per se is frequently associated with a redundant colon [2], as are idiopathic congenital (Hirschsprung’s disease) or secondary megacolon. All these conditions display abnormalities of the enteric nervous system [3, 4], likely responsible for possible anatomic abnormalities. In addition, there is objective demonstration that the use of psychotropic drugs may cause constipation [5, 6], and that colon elongation is responsible for delayed colonic transit [7]. Thus, to substantiate their claims the authors should have demonstrated that colonic morphology, normal at a basal examination, modifies in the time course following the use of drugs. This is difficult to understand, and no known pathophysiologic mechanism related to the use of drugs to date has been shown to influence the anatomic architecture of the large bowel. Of course, the human colon is highly susceptible to drug injuries [8], mostly involving the mucosa and often presenting peculiar endoscopic aspects [9], but these do not modify the viscus’s anatomy. Thus, we want to express our concern about the claims of Tan et al., since should their message be widely accepted by the medical community, this would imply that psychotropic drugs must be banned in that they are able to modify the gross anatomy of an abdominal viscus and that refraining from their use would eliminate a large percentage of megacolons or redundant colons. This concept, although appealing, is not substantiated by solid data and at the very best appears quite unlikely. Conversely, we want to stress, once again, that many (and, especially psychotropic) drugs can cause constipation [10], and that physicians must have a profound knowledge of the compound they prescribe and be aware of the potential side effects of the drugs they use, in order to inform their patients and, if necessary, to adopt preventive measures or to treat constipation (or other unwanted effects) when offending compounds are needed to treat pathological conditions that impair health and the quality of life.