Abstract
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.
Works Cited
Aprile, 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