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Overview
The first comprehensive guide to Prozac—separating the facts from the myths about the drug many doctors believe is the best medication available for the treatment of depression—a serious illness that affects fifteen million Americans.
Dramatic evidence suggesting Prozac may be effective in treating disorders, obesity, obsessive-compulsive disorder, alcoholism, panic and anxiety, and other major illnesses.
Important conclusion from the latest scientific research to help you assess the benefits—and risks—of Prozac
The facts about how much Prozac you may need to take and for how long—and what happens when you stop.
If you’re taking Prozac now or think you may in the future you need this book!
Product Details
| ISBN-13: | 9780307785251 |
|---|---|
| Publisher: | Random House Publishing Group |
| Publication date: | 06/01/2011 |
| Sold by: | Random House |
| Format: | eBook |
| Pages: | 160 |
| File size: | 2 MB |
Read an Excerpt
INTRODUCTION
Melissa* entered my office, her face as sunny as the burgeoning spring visible through the window. The contrast from the Melissa I remembered from the month before was astounding. For a minute I thought I was seeing another person. And in a way, I was.
When I had admitted her to the hospital a month before, this thirty-three-year-old housewife felt as low as she had ever felt in her life. She wanted to cry but couldn’t. She had no energy, took no pleasure in anything, and was barely able to run the household and look after her nine-month-old daughter. She fought constantly with her husband and was sure he was about to leave her. She felt horribly guilty that she was destroying her family, and could see no hope that things would ever change. The future, she said, was like a long black tunnel, with no light at the end, with no way out.
Her family doctor had given her a prescription for an antidepressant, which she had taken faithfully, but which made no difference. The situation had deteriorated by the time she came to me. I admitted her to the hospital and switched her medication.
A month later, almost completely recovered, she was on her way home and had stopped by my office to say good-bye. “I feel like a veil has been lifted from my brain,” she said, smiling. “It was as if I’d had a headache every day for a year, and now it’s gone.”
The thing that made all the difference was a new drug: Prozac.
Two weeks later, however, I got a frantic phone call. It was Melissa. She was crying so much I could hardly make out what she was saying. At first I thought she was suffering a relapse, that her medication had quit working and her depression was back. It turned out she had heard someone on the news reporting that Prozac could cause people to become hostile, violent, even suicidal. “I feel so good with this drug,” she sobbed. “Is it going to make me kill myself? Are you going to take it away from me?”
PROZAC IN THE NEWS
In the spring of 1990 Newsweek magazine featured Prozac on its cover. The illustration featured an enormous two-toned drug capsule floating dreamily above a serene and endless landscape. The words on the cover trumpeted, “PROZAC: A Breakthrough Drug for Depression.” Titled “The Promise of Prozac,” the article included pictures of happy, smiling people whose lives had changed after taking Prozac. Without reading a word of the article you could pretty much guess its tone: Clap your hands, ring the bells, another medical miracle!
Just a few months earlier, New York magazine had run a similar piece, also as a cover story, titled “Bye-Bye Blues: A New Wonder Drug for Depression.” This article also contained lots of uplifting anecdotes about patients whose lives had been turned around after using Prozac.
Seizing on reports that Prozac, unlike other antidepressants, did not usually promote weight gain, the National Enquirer, in bold headlines, called Prozac a “miracle diet pill.” TV talk shows buzzed with Prozac prattle. Stories touted Prozac as a treatment for everything from eating disorders to personality disorders, from obesity to substance abuse. One psychiatrist, quoted in the New York article, even wondered if one day everybody might be taking Prozac.
A Happy Pill that ends all of your problems and has no serious side effects? And that may even help you lose weight? Who wouldn’t want such a thing? Due largely to such media exposure, people with only a vague idea of what depression was decided they were depressed, visited their doctors, and demanded a prescription for Prozac. Sales of the drug—already the best-selling antidepressant on the market, even at a hefty sticker price of around a dollar and a half for each 20-milligram capsule—continued to skyrocket. Over 800,000 prescriptions for Prozac were being written each month.
There were some clouds on the horizon, however, threatening to rain on this media parade. Somewhere toward the end of the Newsweek article, there was mention of a report from Harvard Medical School. That report, which appeared in the February 1990 issue of the American Journal of Psychiatry, was—on the surface, anyway—alarming. It warned that as many as 7.5 percent of patients taking Prozac may be at risk of experiencing “intense, violent suicidal preoccupation.”
Then other reports began trickling in of people who were being treated with Prozac for depression and became hostile or violent. Some of these people lashed out violently, attempting suicide or performing acts of self-mutilation. In one notorious case, a man went on a rampage, killing eight people, wounding a dozen others, then killing himself. An autopsy revealed the presence of Prozac in his bloodstream.
Product liability lawyers saw their opportunity. Eli Lilly, Prozac’s manufacturer, was peppered with lawsuits charging that the drug caused some people to become suicidal or, even worse, triggered violent rampages. The suits—most of which cited the Harvard study as their supporting evidence—claimed that Lilly had not tested the drug sufficiently before putting it on the market.
The fire was fanned again when, in the fall of 1990, someone shot and killed Rabbi Meir Kahane, the controversial founder of the Jewish Defense League. Officials subsequently revealed that the accused gunman was a psychiatric patient being treated with Prozac. However, the suspect was also taking as many as four other psychiatric medications. He had suffered a severe electrical shock during an industrial accident some years earlier, losing partial use of one of his legs. Though highly qualified as an engineer, he could only find jobs as a maintenance worker. Despite these circumstances, any one of which might have been enough to trigger violence in someone suffering from severe mental illness, the implication in news reports was that Prozac was to blame for what had happened.
THE “BORING” MEDICINE
Media attention suggests that Prozac is an “exciting” medicine. Frankly, I think it’s boring. Why? Because by and large it works—it works well and there are very few surprises.
Not that this is to be viewed as a complaint. In medicine, “boring” is better. Doctors would gladly forego the “excitement” of dealing with side effects, adverse reactions, and emergency phone calls at four in the morning. The excitement for them comes from hearing patients like Melissa tell how their lives have changed—that they feel good for the first time in years, that the “black dog” of depression has stopped nipping at their heels. When treating depression, excitement comes not from something out of the ordinary, but from seeing patients return to normal.
However, with recent reports of people becoming suicidal or violent while taking Prozac, there is a sudden element of concern. “What’s this? Prozac—the medical miracle, the breakthrough drug, the promising new star that’s supposed to make everyone happy—can drive people to kill themselves?”
THE FACTS OF THE MATTER
News reports do not always tell the whole truth. For one thing, suicidal thoughts are a known symptom of depression. According to the psychiatrist’s “bible,” the Diagnostic and Statistical Manual of Mental Disorders (third edition, revised), one of the criteria for recognizing the presence of major depression is
recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
The National Institute of Mental Health (NIMH) has even stated that, for at least 15 percent of severely depressed people, there is no relief but suicide. In fact, as many as eight out of ten suicides are believed to be associated with some form of depression. Given that people with depression are known to be at very high risk of suicide, it’s extremely hard to prove that suicidality is a result of their medication. After more than two decades of research, it has yet to be proved that a drug therapy caused suicidal thinking. The evidence indicates that great numbers of patients stop thinking about suicide while on antidepressants.
The lawsuits against Eli Lilly generally claim that the manufacturer failed to test the drug adequately before putting it on the market. In fact, close to 11,000 people had been given Prozac in clinical trials. The United States Food and Drug Administration, which spends years meticulously reviewing the safety data before approving a drug for release, has never issued a warning that Prozac is unsafe. Literally millions of people with depression have taken the drug, and it seems reasonable to infer that Prozac may well have prevented thousands of suicides that might otherwise have occurred.
There are many other issues involved here—whether the Harvard study cited reflects good scientific practice; whether a drug can be said to trigger suicide in people suffering from an illness whose symptoms include suicidal tendencies; whether other risk factors for suicide, such as a family history of mental illness, may have some bearing on the problem. This book addresses these and other issues in detail.
You may be wondering, is there in fact any danger associated with Prozac? Of course. Any drug powerful enough to produce a clinical benefit is powerful enough to cause side effects. Usually, as you will see later, the side effects of Prozac—nausea, disturbed sleep, anxiety—are not serious. They go away after a few days, and most people feel so much relief from having their depression lift that they happily tolerate some temporary and minor discomfort.