At first it was the cure all people were looking for. Then it became the drug
they were afraid to take. Somewhere between these two extremes lies the truth
about the drug Flouxetine, better known as Prozac, the most widely prescribed
drug on the globe. It is mainly prescribed to patients suffering from clinical
depression. It was first brought to the market in 1988 by the pharmaceutical
giant Eli Lilly co. Even though it was originally prescribed for depression, it
has been prescribed for everything from eating disorders to insomnia. It was
first considered the wonder drug of the new decade because of the way it helped
depression patients when no other anti-depressant could and then also found to
help many other personality disorders as well. But now it is frowned upon by
many. Some of the side effects contributed to the growing opposition of Prozac
include nausea, constipation, memory impairment, and excess sweating, just to
name a few. What is depression? Depression can result from a physical disease, a
mental illness, or it can be a recurring reaction of the body. According to the
National Institute of Mental Health, major depressive illnesses are often the
result of imbalances in neurotransmitters in the brain. It is these critical
chemicals that send messages between nerve fibers and control mood (Creamer, 3).
Older anti-depressants worked on three different neurotransmitters, serotonin,
norepinepherine, and dopamine. However, it has been found that serotonin is the
specific chemical in the brain that controls moods. It▓s job is to carry
an impulse from one nerve fiber to the next. Serotonin is released by the nerve
into the space between nerve fibers, carries the impulse to the next one, and is
then reabsorbed by the first. when it is reabsorbed to quickly, a person feels
depressed (6). ⌠Clinical depression■ includes at least five of the
following nine symptoms: 1. Feelings of sadness or irritability. 2. Loss of
interest or pleasure in activities once enjoyed. 3. Changes in weight or
appetite. 4. Changes in sleeping pattern. 5. Feeling Guilty, hopeless or
worthless. 6. Inability to concentrate, remember things, or makes decisions. 7.
Fatigue or loss of energy. 8. Restlessness or decreased activity noticed by
others. 9. Thoughts of suicide or death. Dr. Brian K. Martin, President of the
Mental Health Association of Hawaii, recommends that anyone who has suffered
five or more of these symptoms for two weeks or longer see a doctor (7).
Nationally, the Mental Health Association estimates that only one-third of those
suffering from depression actually seek help. Most are restrained, according to
the association, ⌠by fear, lack of knowledge, misinformation, and
stigma.■ Depression is also the leading cause of suicide. It is estimated
that 15 percent of seriously depressed people take their own lives (7). The cons
of Prozac Historically, the use of drugs as fixers of the world▓s private
ills has run into serious, if unanticipated, snags. At the turn of the century,
the medical community thought that Cocaine was a completely appropriate,
nonaddictive drug, and widely prescribed it. In the 1950s and ▒60s, first
barbiturates and then amphetimines were recommended for various psychological
ailments. we now know that each of these drugs came with significant risks. So
what yet-to-be-imparted knowledge may cause science, once again, to admit
sheepishly that the exuberance over Prozac was somewhat premature, if not wholly
overblown? Possibly, the biggest argument against this drug is merely the fact
that it is prescribed for just about anything. It is estimated that it brought
in over 1 billion dollars last year to Eli Lilly, the pharmaceutical company
that brought us this wonder drug about ten years ago. It is prescribed for
everything from eating disorders to panic to helping with premenstrual syndrome
(PMS). David Dolan, Clinical director of one of the psychiatric programs at
Jefferson Hospital in Jeffersonville Ky., agrees with many that Prozac is way
oversold as a cure-all when it first hit the market. ⌠All of a sudden,
Prozac was the medication for everything, then all of a sudden it was anything
but. Almost overnight, a new phenomenon hit Louisville: Prozac panic. Instead of
asking for, people were afraid to take it■ (Aprile, 2). The change
occurred in the weeks following Joseph Wesbecker▓s rampage, where he
fatally shot eight people and injured 12, only to finally kill himself. After
the shooting, lab tests revealed therapeutic levels of Prozac in his blood.
Three other antidepressants and two other prescription drugs were also found in
his blood in tiny amounts. Wesbecker▓s medical charts indicated that his
psychiatrist thought Prozac may have been contributing to his worsening
condition. At that time, Jefferson County Coroner Richard Greathouse rose
speculation about Prozac▓s possible link to Wesbecker▓s violent
behavior. No connection was ever established, although the inquest jury later
ruled that side effects from various drugs ⌠may have been a contributing
factor■ (2). Researchers from Harvard Medical school issued a sort of
warning about Prozac in an issue of the American Journal of Psychiatry. In a
case study report of six depressed patients with complicated psychiatric
histories, researchers from the school▓s psychiatry department describe
what they call a ⌠surprising■ and unusual side effect of taking
Prozac. ⌠Persistent obsessive and violent suicidal thoughts■ were
experienced in patients not having those thoughts prior to taking the
prescription. Though they admit much further study is needed to determine
whether this is a ⌠widespread or valid concern,■ they urge other
doctors to ask about suicidal thoughts in patients who the study suggests may be
at risk, including those who develop intense fatigue, restlessness or
hypersomnia while taking Prozac (4). In February, 1990, Dr. Martin Teicher, a
psychiatrist at the highly regarded McLean Hospital in Belmont, Mass., and two
of his colleagues reported that six depressed patients began to have suicidal
thoughts after using Prozac. Writing in The American Journal of Psychiatry,
Teicher said that when they began taking the drug, none of the six patients were
suicidal and all were ⌠hopeful and optimistic■ about the treatment.
After that, a sudden flow of reports told of violence and suicide among Prozac
users. And the drug acquired a tenacious enemy in the Los Angeles-based Citizens
Commission on Human Rights, which has ties to the Church of Scientology, a
movement that, amongst other things, opposes some aspects of psychiatry. The
Scientologists claim that by Sept. 16, 1993, no fewer than 1,089 suicides had
been recorded among patients taking the capsule. If that figure is correct, than
it works out to be about .01 percent of the 11 million people who have used the
drug (Nichols, 3) Dr. Lorne Brandes, A Winnipeg cancer researcher, claims to
have evidence that Prozac may promote the growth of cancerous tumors.
⌠I▓m very concerned about Prozac,■ says Brandes, who reported
in 1992 that rats and mice with artificially induced cancer showed an increased
rate of tumor growth when they were given Prozac and another antidepressant not
mentioned. Brandes▓s findings alarmed some cancer researchers and prompted
federal scientists to launch similar studies (Nichols, 1). Although Prozac has
fewer side-effects that earlier antidepressants, it does have some. Users may
experience nausea, nervousness and insomnia, and their sex lives may suffer
some: a U.S. study, published in The Journal of Clinical Psychiatry, found that
among 160 patients on Prozac, 54 reported that sexual desires or responses
diminished after they began taking the drug (1). Sidney Wolfe, director of the
Public Citizen Health Research Group, a Washington based consumer advocacy
organization, compares Prozac to Valium, the popular tranquilizer that was on
the market for more than 10 years before doctors discovered its highly addictive
properties during the mid-1970s. ⌠Prozac has become the Valium of the
1990s,■ declares Wolfe (Nichols, 4) Finally, one of the weaker arguments
against Prozac is that it is very expensive, with a cost of about fifty dollars
for a month▓s supply. It costs more than older drugs now available as
generics, like amitriptyline (Aprile, 3). The Pros of Prozac In defense of
Prozac, Eli Lilly officials say that it is one of the most thoroughly tested
medications in history: more than 32,000 people took part in Prozac▓s
clinical trials, and scientist have conducted at least 3,000 separate studies.
⌠Nothing alarming has shown up,■ says Cameron Battley, corporate
affairs manager for Lilly. He also insist that, despite reports of the drug
being used to treat people who do not really need an antidepressant,
⌠there is absolutely no indication of any inappropriate use of
Prozac■ (Nichols, 2). When Eli Lilly and Co. won Federal Food and Drug
Administration(FDA) approval for Prozac in December of 1987, it was specifically
for the treatment of depression. But there▓s been plenty of publicity
about the drug▓s potential for helping people with a host of other
maladies, ranging from obesity and bulimia, to panic attacks, alcoholism, PMS,
smoking addictions and obsessive-compulsive disorders (Aprile, 1). Although
Jefferson County Coroner Richard Greathouse was quoted earlier to suspect Prozac
in Joseph Wesbecker▓s violent rage, he says, ⌠I want to go on record
saying I am not indicting this drug.■ He says he only raised questions; he
never drew conclusions. ⌠I personally am not afraid of the drug,■ he
said. In fact, Greathouse prescribes it in his own private pediatrics practice.
He also goes on to say that his investigation--which included a study of
⌠a complete FDA file on Prozac about yea-deep■--convinced him that
there was no proven link between the use of the drug and violent behavior.
⌠The whole problem is, would they have done it anyway? Would they have
taken a violent, destructive path regardless? That▓s the $64,000
question■ (Aprile, 2). Drugs to fight depression have existed for more
than thirty years. The first type was Tricyclic antidepressants, like Elavil.
Those were then followed by MAO inhibitors, like Parnate or Nardil. Both of
these types of drugs relieve depression by acting on substances in the brain
that regulate emotional highs and lows. Prozac is considered a breakthrough
because of the ⌠selective■ way it works. Unlike tricyclics, Prozac
rarely causes the adverse effects typical of Tricyclic antidepressants--dry
mouth, confusion, constipation, dizziness, blurred vision, heart problems, and
weight gain. Also, it is easy to take a 20-milligram pill, once a day, which is
a standard beginning regimen, and tends to lift depression relatively quickly
and appears difficult to overdose (3). According to Edward West, director of
corporate communications for Lilly, the company knows of fewer than ten physical
assaults and two murder-suicides committed by anyone on the medication. These do
however, include Wesbecker▓s rampage. West told a Courier-Journal reporter
that the firm sees ⌠no trend that suggests a casual relationship between
Prozac and assaultive type of behavior.■ The FDA agrees. Eva Kemper, a
spokeswoman for the federal agency, said the number of Prozac-related homicides
and violent incidents is ⌠not-high■ for an antidepressant as popular
as it is (4). In the 1992 British Journal of Psychiatry, authors, A.C. Power and
P.J. Cowen analyzed a broad number of studies involving Prozac and suicide. They
concluded that controlled trials do not show Prozac leads to a worsening of
suicidal ideas. Eli Lilly▓s spokeswoman, Kelly Weston, says that the
drug▓s suicidality was repeatedly tested in clinical trials and results
actually showed that patients on Prozac experience suicidality less frequently
than patients on a placebo or another antidepressant. The same thing has been
shown in terms of violent behaviors. Antidepressants like Prozac seem to have a
protective effect. The tendency toward violence will actually decrease. Dr.
James Brookes, a Toronto general practitioner, says that there is generous
praise from doctors and patients for an antidepressant that has made it easier
to treat a debilitating illness. The side-effects of older
antidepressants--including a parched mouth, difficulty in urinating and feeling
of psychological detachment-- made them hard to take. ⌠There were serious
problems involved in getting patients to tolerate those drugs in therapeutic
doses,■ says Brooks, ⌠but, with Prozac, you don▓t have this.
I▓m really pleased with Prozac.■ ( Nichols, 2) Many patients are
equally enthusiastic. William Pringle, Vancouver special events organizer, was
flattened by a major depression. His doctor put him on Prozac. ⌠I fell
into a dark pit,■ says Pringle. ⌠Prozac pulled me out and got me
relaunched on my life.■ Maria Theresa Spagnuolo of Toronto began taking it
in 1989, after three automobile accidents left her with chronic pain throughout
her body. And she also suffered serious depression. Spagnuolo found that she
⌠was crying about everything, spilled milk was a catastrophe. But Prozac
gave me energy and changed my outlook so that I can cope with life. I
don▓t think I could function without it■ (2). For one Hawaiian
business woman, who had a steady diet of antidepressants and psychotherapy off
and on for 20 years before Prozac, but never lost her sense of despair, the past
three years with Prozac have been miraculous. ⌠I felt fabulous not as in
`up`, but as in `my god, I started to be normal,`■ she said. ⌠ Now I
get sad when there▓s reason to be sad, but I don▓t feel
hopeless■ (Creamer, 1). In conclusion, the positives of Prozac definitely
outweigh the negatives. All medications will have some side-effects, that is a
given. Everything from Aspirin to Advil to prescription Penicillin have some
kind of side effects, but everyone still takes these medications. Why, because
they work. No-one can argue that Prozac is working for many people, considering
that it is the most prescribed drug in the world. But if it is not right for
you, then you need to find what is good for you, not everyone can take every
kind of medicine. Some people have allergies, that`s going to happen. The bottom
line is, it is difficult to argue with clear results.BibliographyAprile, Diane. Prozac. Courier-Journal Feb. 18, 1990 Bihm, Barbara; Wilson,
Billie Ann. Understanding Fluoxetine (Prozac). Medsurg Nursing Feb. 1, 1996
Creamer, Beverly. Prozac: Its Effects Still Subject to Debate. Honolulu
Advertiser May 30, 1993 Mauro, James; Breggin, Peter. And Prozac for All...
Psychology Today July 1,1994 Nichols, Mark. Questioning Prozac. Maclean`s May
23, 1994: 36-41 Fluoxetine (Prozac) fluoxetine (Prozac) The Pros and Cons of
Prozac Ken Berardis