Seratonin Reuptake Inhibitors Essay, Research Paper

Seratonin Reuptake Inhibitors

Although the trend to fix an array of psychiatic problems has been to take a medication of a seratonin elevator, doctors are overlooking possible side effects of these drugs when wrongfully prescribed.

The seratonin uptake inhibitors (SSRIS), Prozac, Paxil and Zoloft have become the latest soultion to cure peoples depression. In the pharmacutical companies publications for these miracle pills, it appeared that anyone with a disliked personality quirk could obtain these drugs and fix their personality. Pharmacutical companies such as SmithKline Beecham (makers of Paxil and Zoloft) and Lilly ( maker of Prozac) have become a gigantic barrier in collecting all the facts regarding these drugs. These pharmacutical companies invest millions of dollars each year in advertising their product, giving marketing products to doctors, donations to medical schools and grants for medical students. Are Americans really getting an untainted look at these drugs? While pharmacutical companies lure doctors in with valuble incentives to prescribe these drugs people are being wronfully diagonsed and wrongfully prescribed. The true side effects of these drugs need to be exposed . There should be a more extensive screening for who is placed on these drugs, and safer alternatives should be offered initially by psychiatrists.

The issue of doctors wrongfully diagnosing patients is a very serious one. In studies the SSRI drugs have shown severe side effects in some patients. Currently, the gunman of the Colombine High School shooting are being investigated for being on Prozac. If no limitations are placed on these drugs it is possible for more devastating side effects to harm other people.

“Never before Prozac has a medication been so misrepresented by so many people for so long in the absence of adequate data.” Drs. Dewan and Masand

Ann Blake Tracy, holds a Doctorate in Psychology and Health Sciences, is the director of the International Coalition for Drug Awareness, She has testified before the FDA and congressional subcommittee members on Prozac. She also testified in 1992 as an expert witness in Prozac and other SSRI related court cases around the world. She writes;

Prozac and its analogues are being prescribed for everything from headaches and flu to acne and home sickness. Yet, according to FDA spokespersons, there have been more adverse reaction reports on Prozac than any other medical product.

As of October, 1993, a total of 28,623 complaints of adverse side effects had been filed with the FDA, including 1,885 suicide attempts and 1349 deaths. The FDA’s general rule of thumb for estimating the true figures is that these reports represent only one to ten percent of the actual figures. This would indicate the staggering amount of 286,230 – 2,862,300 actual adverse reactions, 18,850 – 188,500 actual suicide attempts and 13,490 – 134,900 actual deaths attributed to Prozac by the end of 1993. We are being told these new mind-altering chemicals have a large margin of safety. Considering the widespread use of these products, we have no time to waste in discovering the truth behind these drugs.

In 1956 Eli Lilly patented LSD . In 1987 Eli Lilly gave us Prozac. LSD, the most notorious of the psychedelic drugs, was first marketed by Sandoz in Europe with the suggestion that it be used to chemically induce insanity in “normal subjects.” The reason was to discover how mental illness is produced. Yet in December 1955, two months before Lilly obtained their patent on LSD in America, TIME featured the drug, declaring that LSD “may actually help psychiatrists clear up mental illness.” It was also promoted as a cure for alcoholism and as an “aid in facilitating psychoanalysis”. It was even considered a safe medication for pregnant women. How many are aware that the finest physicians once recommended LSD as a miracle cure?

Year 2000, many of the same marketing claims are being made for Prozac that were once made for LSD. Just how similar in action are these two drugs? How much evidence is there that those who feel they cannot live without Prozac, Zoloft, Paxil, are addicted to these drugs or dependent upon them?

Recent medical studies demonstrate that the brain levels of Prozac are 100 times greater than blood levels and it is believed that this is the case with the other serotonin reuptake inhibitors as well – evidence of toxic brain levels affecting behavior no matter what the blood levels demonstrate. This accumulation is evidence that the drug residue will produce a delayed withdrawal and continue to produce reactions, not only during the period of time the patient is using the drug, but for long periods of time after discontinuation of the drug use.

Brain wave patterns indicate patients are in a total anesthetic sleep state while appearing awake and functioning. Increasing serotonin – exactly what these drugs are designed to do – induces both nightmares and sleepwalk. Patients report over and over again that they have lived out their worst nightmare. And as with sleepwalk episodes, many have no recall or little recall of what they have done. Often someone must prove to them what they have done while they where under the influence of these drugs before they will believe it to be true. One patient stated that he could not detect during his two year use of Prozac what was real or what was a dream!

Seven to ten percent of patients do not have the liver function necessary to metabolize these drugs. Unfortunately, even if they do have a functioning liver system to metabolize the drugs, this group of drugs totally saturates that liver system so that the ability to metabolize the drug gradually becomes greatly impaired and the metabolism of other drugs becomes greatly impaired.

Stress or depression can be detected by elevated levels of cortisol, yet one single 30mg dose of Prozac clearly doubles the level of cortisol. This should in the long run double the patient’s stress and depression. But that is not the only detrimental effect of elevated cortisol levels. This can cause a multitude of serious physical and emotional adverse side effects.

These drugs given to children is absolutely unconscionable for many reasons – only one being that increased cortisol impairs the development and regeneration of the liver, kidney and muscles, as well as impairing linear growth. Yet, learning that even one parent was given this information would be surprising.

What concerns some doctors, including Listening to Prozac author Peter Kramer, is that the drug’s long-term effects are largely unknown. A series of studies in humans has shown no connection between antidepressant use and cancer, but there are some concerns about whether antidepressants promote tumor growth in cancer patients or in those exposed to cancer-causing substances (such as nicotine in cigarettes). This concern is primarily due to a small study published in 1992 that found that after being injected with cancer cells or cancer-causing substances, rats subsequently injected with antidepressants had more tumors than control rats.

Cost is also an issue. Older antidepressants like the MAOIs and the tricyclics are cheaper than Prozac and the SSRIs because their patents have expired; they are less expensive compared to these wholesale price tags of some of the newest.

Tolerance is a concern. (A person develops drug “tolerance” when the drug suddenly stops working, requiring larger and larger doses to be effective.) About one in 50 patients will develop tolerance to any drug, doctors say, and there have been reports of tolerance with Prozac.

Sherry, 38, has suffered for some time with many health problems, including obesity and chronic pain from arthritis. Depressed over these health worries, she began taking one capsule of Prozac daily, which eased her depression at first. She’s now up to five tablets daily (100 milligrams), a very high dose indeed.

“The crying episodes have stopped,” she says, “but Prozac is just not very effective anymore. Before, I was always able to pull myself back from depression. Now I’m just crazed, and I’ve lost faith in traditional medicine.”

Some people report strange feelings of loss on Prozac. They feel as if they have changed in some very basic, profound way. They appear to be a little uncomfort-able at the thought that while they are not depressed, neither are they the same person. Some mental health experts believe this could be the result of suddenly achieving normal mood after years of having adapted as a depressed person..

This uncomfortable feeling of loss is not unique to Prozac; people taking other SSRIs report similar experiences, especially among those who have battled depression for many years. There’s an ongoing controversy about whether Prozac causes people to try to kill themselves, or whether suicide attempts by users of Prozac are the result of the depression itself.

Studies have shown that at the beginning of treatment, 10 percent to 15 percent of patients feel more anxious after taking Prozac, but this anxiety eventually passes.

There also have been reports of anger and irritability among users of Prozac. Very irritable patients usually find their temperaments improving on Prozac, but it’s a different story with manic-depressives. If manic highs involve anger, paranoia, or irritability and you take Prozac without first being stabilized on lithium, the manic side of your mood may break through and you could experience these symptoms. Many scientists believe that Prozac may initially increase manic symptoms because the drug increases a person’s energy before it has successfully altered mood. This could suddenly prompt a suicide attempt in someone who had previously been too lethargic to make the effort. Indeed, several studies have suggested that people who are slowed down by depression in this way do appear to have a temporary increased risk of suicide as the depression eases.

1990 created a backlash in Prozacs popularity after reports circulated that it induced violent and suicidal tendencies in some users. The Church of Scientology led the attack against the drug, which focused on a small group of patients who had suicidal or violent thoughts.

In 1990 the church filed a citizen’s petition with the U.S. Food and Drug Administration asking that Prozac be withdrawn from the market, citing a Harvard Medical School study published in the American Journal of Psychiatry stating that 6 out of 172 high-risk mental patients who had been resistant to other drugs had become preoccupied with violent suicidal thoughts while on Prozac. Two of them tried unsuccessfully to kill themselves. Although none of the six had appeared to be suicidal when they started taking Prozac, five had had suicidal thoughts before.

The Scientologists took that study’s findings and stated United States will become violent and suicidal on Prozac and charging that widespread use of Prozac would promote waves of violence. They backed up this claim by pointing to mass murderer Joseph Wesbecker, who killed himself and eight coworkers at a printing plant in Louisville, Kentucky, with an AK-47 assault rifle. A Scientology group alleged that man, who they said had no history of violence, went berserk because he took Prozac. Subsequent media reports revealed Wesbecker had a large gun collection, had tried to kill himself 12 times in the past, and had often talked about killing his employers.

Many depressed people are also suicidal, the fact that a few severely depressed patients taking antidepressants became suicidal didn’t surprise researchers. The FDA was concerned, however, because Prozac affects serotonin, a neurotransmitter known to be linked with aggression. After further study, however, in 1991 the FDA rejected the petition, reaffirming Prozac’s safety. This decision was followed two months later by a unanimous announcement by the FDA advisory committee and an independent scientific advisory committee that Prozac and other antidepressants do not cause violence or suicidal behavior, and that Prozac, on the contrary, appears to guard against violent behavior. The announcement included the information that large-scale studies show that people taking Prozac are less suicidal than those taking a placebo or other antidepressant drugs. This affirmation of support was backed by the National Mental Health Association and the American Psychiatric Association.

The Diagnostic and Statistical Manual of Mental Disorders (DSM), which contains the signs and symptoms of various psychiatric problems describes what qualifies one to fit in a particular type of depression. A panel of distinguished psychiatrists revises the DSM periodically. The manual is now in its 4th edition (DSM-IV). This document is key in determining who should be placed on the SSRIS. The DSM-IV recognizes several types of clinical depression:

Normal Depressed Mood & Grief

These conditions are natural reactions to losses in life. They typically involve sadness, lethargy, and in serious cases — for example, grief after the death of a loved one — often despair, anger, insomnia, poor appetite, or weight gain, obsessive thoughts about the lost person, and terrible guilt about any problems in the depressed person’s relationship with the deceased individual. What makes these reactions normal is that people eventually recover. After losing a ball game, it may take a day or two to bounce back. After a lay-off, it may take a few months. After the death of a loved one, it may take up to a year. If symptoms persist, they have a clinical depression and should call a doctor.

Adjustment Disorder with Depressed Mood

When People are faced with changes many people feel overwhelmed and “crazy” for a while. Then they get things under control. If they don’t, and they become persistently gloomy, angry, and unable to cope, it’s most likely adjustment disorder with depressed mood. Adjustment disorder with depressed mood presumes a change you have to adjust to.

Mild Depression (Dysthymia)

Dysthymia involves chronic depressed mood, poor self-esteem, and low-level symptoms of major depression “People with mild depression can still function, but they’re sad sacks,” says San Francisco psychiatrist Michael Freeman, M.D. “They consider themselves losers.”

Dysthymia may or may not have a triggering life event. Quite often, there is nothing to blame it on — no loss or life change. This can be confusing for both the person affected, and their loved ones. But just as you can catch a cold seemingly out of nowhere, you can also slip into dysthymia for no apparent reason.

Major Depression

When people say “seriously depressed,” this is what they mean. Major depression often causes despair and hopelessness so profound that the person loses interest in life, becomes incapable of feeling pleasure and sexual arousal, and may be unable to get out of bed or eat for days at a time. This illness may also cause other symptoms not easily recognized as depression: weight loss or gain; anxiety, irritability, or agitation; chronic indecisiveness; or sleep disturbances (insomnia or sleeping all the time). In other words, you can suffer a major depression and not feel blue.

Very often, major depression strikes without any triggering loss. This can be confusing and frustrating for both the person affected, and their loved ones. We want our illnesses to have clear causes. But many serious diseases do not: diabetes, cancer, arthritis. That’s how it is with major depression. It’s a serious disease that often develops with no discernible triggering event.

Officially, according to DSM-IV, major depression involves at least two weeks of deep despair and at least four of the following:

 Sleep problems. Insomnia or sleeping all the time.

 Appetite problems. Loss of appetite or major weight gain.

 Lack of energy. Apathy, lethargy, no interest in anything.

 Feelings of worthlessness, hopelessness, and/or terrible guilt.

 Difficulty concentrating, or unusual indecisiveness.

 Suicidal thoughts, or suicide attempts.

Beyond the almost unbearable misery it causes, the big risk in major depression is suicide. Within five years of suffering a major depression, an estimated 25% of sufferers try to kill themselves. The myth is that people who talk about suicide don’t attempt it. The fact is that many people announce their intention before their suicide attempts. Take any talk of suicide very seriously, and make sure the person gets professional help. Call their doctor immediately, if possible.

Bipolar Disorder (Manic-Depression)

About 1% of the American population experiences bipolar disorder annually. This illness involves major depressive episodes alternating with high-energy periods of wildly unrealistic activity. A manic friend might, for example, call at 3 a.m. to announce in all seriousness that she’s flying to Hollywood immediately to marry Robert Redford, and star in his next movie.

Typically, bipolar disorder develops without any clear cause.

Atypical Depression

“Atypical” means unusual. Instead of feeling unrelenting gloominess and lethargy, a person with this condition might seem deeply depressed for a few days, then fine for a while, or anxious and irritable.

Like many other forms of depression, the atypical variety often develops without a triggering event.

Seasonal Affective Disorder (SAD)

This condition is often called “winter blues.” A reaction to lack of sunlight in winter, mild or major depression develops in late fall and clears up in early spring. As distance from the equator increases, this condition becomes more common. In the northern hemisphere, December, January, and February are the worst months.

Post-partum Depression

New mothers typically expect to feel overjoyed after giving birth. But because of the enormous hormonal changes of delivery and the challenges of dealing with an infant, some two-thirds of women feel transient sadness. About 10% to 15% become clinically depressed. And about one in 1000 become so severely depressed that they must be hospitalized for their own safety and the safety of their baby.

The first selective serotonin reuptake inhibitor, Prozac, was approved by the FDA in 1987. Zoloft followed in 1991 and Paxil in 1992.

SSRIs may cause sexual side effects. Depending on the study, 40% to 50% of SSRI users complain of one or more sexual side effects, mostly, inability to have an orgasm, but also decreased desire and arousal, erection impairment in men, and loss of lubrication in women.

SSRIs also disrupt sleep. They often cause “micro-awakenings.” Users usually remain unaware of these sleep disruptions, but they appear clearly in sleep studies of SSRI users, and contribute to the fatigue some users cite as a reason for dissatisfaction with these drugs. If SSRIs keep you awake, take the dose before noon each day. If they make you sleepy, take the dose at bedtime.

Generally, SSRIs can cause headache, excessive sweating, nausea, upset stomach, diarrhea, difficulty sleeping, drowsiness, and tremor. A decrease in weight tends to occur more often than weight gain.

Prozac. The recommended initial dose is 20 mg/day. Doses above 20 mg/day may be given in two doses, at morning and noon. If necessary, it may be increased up to a maximum of 80 mg/day. Seniors will require lower dosing, as will people with kidney or liver problems.

Zoloft. The recommended initial dose is 50 mg/day. If necessary, it may be increased up to a maximum of 200 mg/day. Seniors will require lower dosing, as will people with kidney or liver problems.

PHILADELPHIA, May 7, 1996 — Paxil (paroxetine hydrochloride) was cleared by the U.S. Food and Drug Administration today for the treatment of panic disorder, SmithKline Beecham announced. Panic disorder is a chronic, disabling condition that will affect 3 to 6 million Americans at some time in their lives.

Paxil is the first and only antidepressant indicated for treating panic disorder and the first new drug therapy to be cleared for panic disorder in nearly a decade. Paxil belongs to the class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs

Paxil. The recommended initial dose is 20 mg/day. If necessary, it may be increased up to a maximum of 50 mg/day. Seniors will require lower dosing, as will people with kidney or liver problems.

The side effects: Stopping an SRI too quickly can bring on dizziness, insomnia, vivid dreams, headaches, nausea, fatigue, and/or chills, says panel member Jerrold F. Rosenbaum, MD, associate chief for clinical research in the department of psychiatry at Massachusetts General Hospital in Boston. You might also feel anxious, agitated, or irritable, or have uncharacteristic crying spells.

Why it happens: Your brain must adapt to lower levels of the neurotransmitter serotonin when you quit. “If the chemical makeup of your brain changes abruptly, side effects are more likely,” Dr. Rosenbaum says.

Paxil/Seroxat, up 18% to 1.06 billion ($1.76 billion); the first SSRI approved for panic and social anxiety disorder/social phobia.

SRIs with active ingredients that leave the body quickly — paroxetine (Paxil), sertraline (Zoloft), venlafaxine (Effexor), and fluvoxamine (Luvox) — seem to cause side effects more often than those with components that linger, such as fluoxetine (Prozac).

Alternatives

The research shows that for mild depression, non-drug therapies are as effective as antidepressant medications. For mild-to-moderate depression, non-drug therapies may be sufficient, but many people also need antidepressant medications. The two often work best together.

For moderate-to-severe or severe depression, medications are necessary. But the non-drug therapies can still play a valuable supportive role in treatment.

 Have more fun. In mild depression, this often helps. “Happiness requires action,” says psychologist Jennifer James, Ph.D., author of Women and the Blues. Try not to mope. Visit a friend. Have a massage. Get a pet. Redecorate. Take a class. Take a vacation. If nothing feels fun, do things you used to enjoy.

 Cognitive therapy. You can’t talk yourself out of depression, but you can stop talking yourself deeper into it. Cognitive therapy — also called cognitive restructuring — teaches people to recognize and correct depressive thinking. If you make a mistake at work, you might think, “I’m hopelessly incompetent,” and slide toward depression. That’s “awful-izing” — a thought distortion that magnifies minor upsets into catastrophes. With cognitive therapy, the reaction changes: “OK, I made a mistake. Everyone makes mistakes. Fortunately, my boss and co-workers know I don’t make many. And I can fix this one easily.” A National Institute of Mental Health (NIMH) study showed that after 16 weeks of cognitive restructuring training, 51 percent of those with mild to moderate depression reported significant improvement. “Cognitive therapy also lends itself to self-help,” Dr. Freeman says.

Psychotherapy. Long-term Freudian psychoanalysis has been largely replaced by shorter-term “talk therapies.” The NIMH study showed that after 16 weeks of psychotherapy, 55% of those with mild to moderate depression reported significant improvement. How long is long enough? “For most major depressive episodes,” Dr. Freeman says, “four to five months is usually about right.”

Support groups. Depression feels terribly isolating. Support groups show you that you’re not alone. They are particularly helpful for depressions associated with drug or alcohol abuse, which is why Alcoholics Anonymous and the other Anonymous organizations are so popular.

Herbal medicines. Several medicinal herbs have antidepressant effects. The most powerful is St. John’s wort, a natural SSRI and weak MAO inhibitor. In addition, kava-kava, ginkgo, and caffeine can also help.

Dietary supplements. Certain vitamin deficiencies — notably B-6, B-12, C, folic acid, thiamine, niacin, riboflavin, biotin, and pantothenic acid — can cause depression.

Exersize. Studies have shown that tremendous improvements have been made to decrease symptoms of depression through high cardio vascular exersize. Also, exersize enhances sexual drive as well as acting as an overall mood enhancer.

Acupuncture, aromatherapy, and other alternative treatments. The United Nations World Health Organization recognizes acupuncture as effective for mild-to-moderate depression. Other helpful treatments include aromatherapy, massage therapy, music therapy, and meditation.

Phototherapy. Seasonal affective disorder is caused by lack of sunlight in winter. Supplemental artificial light successfully treats it. A half-hour a day in front of a special bright-light appliance lifts the spirits of 60% to 80% of those with winter depression. Another appliance that simulates an earlier dawn may also be beneficial. Antidepressant medication can help as well. So can midwinter tropical vacations. The emotional benefits typically last a week or two after returning north.

5-hydroxytryptophan (5-HTP) is the less well known cousin of serotonin (5-HT), one of the most important brain neurotransmitters. Tryptophan is first converted to 5-HTP in nerve cells by a vitamin B3 dependant enzyme, and then 5-HTP is converted to 5-HT by a vitamin B6 dependant enzyme. Modern science has creted a way for 5-HTP to be dependantly created.

5-HTP passes through the blood brain barrier into the brain far more easily than tryptophan, and getting tryptophan through the blood brain barrier is the main bottleneck, which in many people leads to inadequate brain serotonin levels.

Tryptophan can be broken down in the liver by pyrrolase, an enzyme that converts tryptophan to kynurenine and its metabolites, which can be mildly liver toxic at high levels. 5-HTP is not metabolized through this pathway.

The work of HM van Praag, SN Young and others over the last 20 years, shows that serotonin is a key brain neurotransmitter involved in mood regulation (anti-anxiety and antidepressant), impulse control (inhibits aggression and obsessive compulsive disorders [OCD], pain control and sleep).

Serotonin is also the precursor for our pineal gland s production of melatonin. Human clinical studies show that 5-HTP is a far more efficient increaser of brain serotonin than tryptophan.

5-HTP has been shown to increase brain dopamine (DA) and noradrenaline (NA) activity. These are two key mood and alertness regulating neurotransmitters, and when tyrosine, the amino-acid precursor for brain DA/NA is given along with 5-HTP, the effect is even more powerful.

Van Praag s and Young s work suggests that 5-HTP is more likely to be effective for those suffering an anxious, agitated, aggressive, irritable depression and is rarely effective for those suffering from a severe, vegetative, total “blahs” type depression.

5-HTP may also be helpful in some cases of compulsive carbohydrate overeating, alcohol addiction and compulsive gambling (specific forms of OCD), as well as for insomnia.

Side effects of 5-HTP are occasional gastrointestinal upset, hypomania and euphoria. Even though 5-HTP is a natural substance normally made by the brain, without medical supervision prudence suggests limiting daily dosage to 100mg to 200mg, a dose shown to be effective in human clinical studies.

Research also shows that 5-HTP, increases the activity of MAO inhibitor drugs, tricyclic antidepressants and selective serotonin inhibitor (SSRI) drugs, such as Prozac, Paxil and Zoloft. Therefore tryptophan and especially 5-HTP, should only be used by anyone taking any of these drugs ONLY with their prescribing physician s consent and supervision.

The idea that prescribing Prozac was a sort of “cosmetic psychopharmacology” was promoted by psychiatrist Peter Kramer, author of the best-selling Listening to Prozac. In his book, Kramer expressed concern that this antidepressant alters personality as well as illness in a “substantial minority” of users. Actually, Kramer says he doesn’t prescribe Prozac that often and notes that it works for a wide variety of problems in addition to depression. His book was not so much for or against Prozac as it was a philosophical exploration of antidepressants and the human personality.

The main difference between Prozac and other SSRIs is that Prozac stays in the body much longer; this has both positive and negative implications. Prozac’s half-life (the time it takes for a drug in the blood to decrease by half of its original dose) is about a week, compared to about a day for Paxil and Zoloft. Up to six weeks after you stop taking the drug, traces of Prozac and its metabolites can still be found in your body. What this means is that if you have a bad reaction to Zoloft or Paxil, the unpleasant symptoms may linger for a week or two. But adverse effects from taking Prozac can last for up to six weeks after you’ve stopped taking the drug.

There’s a benefit to a long half-life, however. You’ll be less likely to experience relapse of depression if you forget a dose or two of Prozac, and you’ll be less likely to have withdrawal effects from suddenly discontinuing the drug.

Neither Prozac nor the other SSRIs cause the same side effects as older antidepressants — dry mouth, dizziness, blurred vision, constipation. Prozac just helps people feel less fearful, more outgoing, and more self-confident.

Serzone — not an SSRI, but a serotonin-related antidepressant — combines the benefits of Prozac with lower price and fewer instances of at least two side effects (insomnia and sexual dysfunction), according to its makers, Bristol-Myers Squibb. While the FDA cautions that no direct comparisons of Serzone have proven its superiority, it does not directly dispute the company’s claims. Bristol-Myers Squibb bases its figures on published reports of other drugs’ effects.

“Before I took Prozac, every day was difficult,” says Joan. “I didn’t get any joy out of anything; everything was futile. There seemed to be no hope. After being on Prozac for about a month, I suddenly felt that half my life had already gone by. I’d better get in gear!

“I used to compare myself with everyone,” she continues. “Now I don’t care. I’m more confident with other people, and I don’t freak out in groups. I wish,” she sighs, “I had the past 20 years back.”

Prozac Vs. Older Antidepressants

Not everyone who is depressed experiences the disorder in the same way, and not everyone responds to the same antidepressant.

The main advantage of Prozac, compared with the tricyclics and MAOIs, is that it produces relatively mild side effects.

“Elavil (amitriptyline, a tricyclic) made me tired and stupid, but not less depressed,” recalls Marie, who tried a number of antidepressants before responding well to Prozac. “The MAOI was fine, but I couldn’t take the diet, and it did weird things to my blood pressure; I kept passing out in inappropriate places. I was in a daze all the time. Of all the drugs I took, Prozac was clearly the best for me. It worked best for the longest period of time, and I didn’t have any side effects.”

Unlike older antidepressants and lithium, which can be quite toxic, Prozac is not very dangerous even in high doses. Faced with suicidal patients, many doctors feel more comfortable prescribing Prozac, since it’s unlikely a person could cause permanent damage by taking too much. (In one case, a patient who supposedly took more than 3,000 milligrams of Prozac did not have lasting physical damage.) Also unlike older antidepressants, it appears to be a good choice if you have heart problems or high blood pressure, since it doesn’t appear to affect cardiovascular function.

Prozac is also a pleasant change for people who just don’t like taking pills, since the total daily dose of Prozac can be taken as one capsule or in liquid form, compared with the three to six pills usually needed for MAOIs or tricyclics.

Finally, unlike the many older antidepressants that cause significant weight gain, Prozac doesn’t cause weight gain in most people and may even cause them to lose a few pounds. This is partly because of the mild nausea people feel during the first few days, but it’s also because Prozac affects the serotonin system and lessens carbohydrate craving. This benefit shouldn’t be downplayed, psychiatrists say, since the weight gain caused by the older anti-depressants — which could be 30 pounds or more — could be a real stumbling block to staying on the drug.

This does not mean that Prozac is some sort of diet pill. It’s more likely to prevent weight gain than to initiate weight loss. Not everybody who takes Prozac loses weight, and most only lose a pound or two. One study found that 25 percent of Prozac users did gain weight, although this ratio still compared favorably to the 65 percent of users who gained weight on tricyclics. Researchers note that the heaviest people are those who tend to lose a few pounds on Prozac, while the slimmest users are the ones most likely to gain.

Side Effects of Prozac

Most common (in order of frequency)

 sexual dysfunction (40 percent)

 nausea (21 percent)

 headache (20 percent)

 insomnia (14 percent)

 diarrhea or drowsiness (12 percent)

Less common (10 percent or fewer patients)

 anxiety

 dry mouth

 appetite loss

 tremor

 upper respiratory infection

 dizziness

Infrequent (fewer than 5 percent)

 fatigue

 constipation

 abdominal pain

 flulike symptoms

 vision problems

 congestion

 sinus infection

 cough

 mania

Prozac’s stimulatory properties also can cause sleep problems in some people, probably because Prozac (like other SSRIs) affects serotonin, responsible for regulating the sleep-wake cycle. Fortunately, only about 2 percent of patients find the insomnia so troubling that they are forced to stop taking Prozac. About the same percentage are equally disturbed by drowsiness with this drug. If you do experience insomnia, you can try taking your medicine earlier in the day, or ask your doctor about combining Prozac with Desyrel (trazodone).

About 9 percent of people taking Prozac report dry mouth, compared to about 65 percent of those taking tricyclics. A few people also notice sweating, tremors, or rash.

Most antidepressants (except for Wellbutrin) cause some degree of sexual problems, and Prozac isn’t any different. As many as 40 percent of people experience some negative sexual effects, including delayed ejaculation, impotence, decreased desire, or problems reaching orgasm. Patients cite loss of sexual interest as one of the biggest problems with Prozac. On the other hand, some people feel more interested in sex than before, possibly because depression had interfered with their libido.

More seriously, Prozac can induce a manic state (excess elation, hyperactivity, agitation, and speeded-up thinking and talking) in people who are inclined to be manic-depressive. This is a real problem, and it’s something your doctor will be watching out for, especially if there’s a history of manic depression in your family. Your doctor may want to cut back your dose or combine Prozac with lithium to manage the mania. Some people may have to stop the drug completely.

“Prozac made me speed up,” says Julie, a 38-year-old woman with a family history of manic depression. “I was scouring every nook and cranny. I had two vacuums going in the bedroom at once, one for the corners and one for the floor. I hadn’t cleaned that much for two years, because I was depressed. Once I took Prozac, suddenly I felt like doing a really good job. The night before I went on the cleaning binge, I lay in bed for two hours thinking that I could smell the dust. As soon as I told my psychiatrist, he immediately took me off Prozac and put me on Paxil.”

There also have been reports of anger and irritability among users of Prozac. Very irritable patients usually find their temperaments improving on Prozac, but it’s a different story with manic-depressives. If manic highs involve anger, paranoia, or irritability and you take Prozac without first being stabilized on lithium, the manic side of your mood may break through and you could experience these symptoms. Many scientists believe that Prozac may initially increase manic symptoms because the drug increases a person’s energy before it has successfully altered mood. This could suddenly prompt a suicide attempt in someone who had previously been too lethargic to make the effort. Indeed, several studies have suggested that people who are slowed down by depression in this way do appear to have a temporary increased risk of suicide as the depression eases.

zac, but this anxiety eventually passes.

Indeed, despite the suits and bad publicity, the popularity of this drug never declined; Lilly’s Prozac sales haven’t had a bad year since the drug was released in 1987. In 1993, sales reached $1.2 billion worldwide ($880 million in the United States alone), surpassing the sales of all previously used antidepressants around the world. Sales are expected to increase another 12 percent in 1994.

There also have been reports of anger and irritability among users of Prozac. Very irritable patients usually find their temperaments improving on Prozac, but it’s a different story with manic-depressives. If manic highs involve anger, paranoia, or irritability and you take Prozac without first being stabilized on lithium, the manic side of your mood may break through and you could experience these symptoms. Many scientists believe that Prozac may initially increase manic symptoms because the drug increases a person’s energy before it has successfully altered mood. This could suddenly prompt a suicide attempt in someone who had previously been too lethargic to make the effort. Indeed, several studies have suggested that people who are slowed down by depression in this way do appear to have a temporary increased risk of suicide as the depression eases.

Prozac experienced a temporary backlash in 1990 after reports circulated that it induced violent and suicidal tendencies in some users; the Church of Scientology led the attack against the drug, which focused on a small group of patients who had suicidal or violent thoughts.

In 1990 the church filed a citizen’s petition with the U.S. Food and Drug Administration asking that Prozac be withdrawn from the market, citing a Harvard Medical School study published in the American Journal of Psychiatry stating that 6 out of 172 high-risk mental patients who had been resistant to other drugs had become preoccupied with violent suicidal thoughts while on Prozac. Two of them tried unsuccessfully to kill themselves. Although none of the six had appeared to be suicidal when they started taking Prozac, five had had suicidal thoughts before. At the time, four of the six were also taking other medications (one was taking five other drugs).

The Scientologists took that study’s findings of the six individuals and extrapolated them to the entire United States population, claiming that 140,000 people in the United States have become violent and suicidal on Prozac and charging that widespread use of Prozac would promote waves of violence. They backed up this claim by pointing to mass murderer Joseph Wesbecker, who killed himself and eight coworkers at a printing plant in Louisville, Kentucky, with an AK-47 assault rifle. A Scientology group alleged that Wesbecker, who they said had no history of violence, went berserk because he took Prozac. Subsequent media reports revealed Wesbecker had a large gun collection, had tried to kill himself 12 times in the past, and had often talked about killing his employers.

Because so many depressed people are also suicidal, the fact that a few severely depressed patients taking antidepressants became suicidal didn’t surprise researchers. The FDA was concerned, however, because Prozac affects serotonin, a neurotransmitter known to be linked with aggression.