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The Dartmouth
March 29, 2024 | Latest Issue
The Dartmouth

New research dulls Prozac's glossy image

Glossy, trendy and a household name, Prozac has become the first prescription drug of our time to transgress the obscure world of medical textbooks and enter the glamorized sphere of popular culture.

And yet the drug's success may not be quite so straightforward.

With growing controversy surrounding Prozac and the emergence of similar anti-depressants, the first quarter of this year -- 15 years after Prozac first hit the market -- has seen the pharmaceutical giant Eli Lilly and Co., manufacturer of Prozac, report an astounding 25-percent drop in earnings.

While some are blaming this drop on Lilly's loss of its patent and the corresponding emergence of less expensive generic versions, others identify another phenomenon: the end of the "happy pill" era.

Once considered a wonder drug, Prozac was believed to be a much more viable, efficient and inexpensive alternative to psychotherapy.

But after 15 years on the market, scientists are now beginning to understand the long-term effects of the drug and why therapy may, many say, be much more beneficial than a prescription.

Approved by the Food and Drug Administration in 1987 as an anti-depressant with "fewer than usual" side effects, Prozac (or fluoxetine) became widely used for treating depression, obsessive-compulsive disorder and bulimia nervosa.

Within two years, pharmacies were filling out 65,000 Prozac prescriptions a month in the United States alone. Within five years, 4.5 million Americans were taking the anti-depressant.

What most people did not know, however, was that two months before Prozac was approved for the market, there had already been 27 deaths from controlled clinical trials. Fifteen were from suicide, six from overdoses, four from gunshot and two from drowning. All the deaths were confirmed as directly related to Prozac.

Though these deaths were reported by the FDA in 1994 -- seven years after the anti-depressant was available for public consumption -- Lilly has only recently admitted that anxiety, insomnia, drowsiness, headaches, sexual dysfunction and weight change can result from taking the supposed wonder drug.

Prozac works by blocking the re-absorption of serotonin, a neurotransmitter in the brain that functions as a pleasure chemical. Prozac causes serotonin levels to be kept purposely high so that the patient experiences high satisfaction levels.

Serotonin, or lack or serotonin, has been linked not only to depression but also to autism, social phobias, premenstrual syndrome, anxiety and panic, migraines, schizophrenia and extreme violence.

Prozac, by tampering with the re-absorption of serotonin, sometimes produces all of these behaviors as symptoms when a patient is using the drug.

A growing number of health experts believe that the drug is over-prescribed without proper understanding of side effects that are only beginning to be understood.

Instances of extreme violence have attracted a national spotlight, especially in the area of school shootings.

Kip Kinkel, a 14-year old who opened fire on his school cafeteria in Springfield, Ore. and killed his parents, was taking Prozac for treatment of severe depression.

The Washington Post confirmed two years ago that Eric Harris, one of the gunmen involved in the Columbine tragedy, was taking the psychiatric drug Luvox, an anti-depressant related to Prozac, at the time of the murders.

Courts have been the first institutions to recognize the role that prescription drugs play in incidents of violence.

Last year, a judge in Connecticut acquitted a bank robber who blamed his criminal behavior on Prozac. In what is thought to be the first ruling of its kind, Superior Court Judge Richard Arnold freed Christopher DeAngelo, a 28 year-old insurance agent, because the defendant was unable to distinguish right from wrong at the time of the robbery.

Defense lawyer John Williams told the London Observer that "this was someone who was driven to commit crimes because of prescription drugs."

Last year, in the first clinical trial of its kind, doctors from the Department of Psychological Medicine at the University of Wales gave Prozac to a volunteer group of mentally healthy adults and found that their behavior was greatly affected.

"We can make healthy volunteers belligerent, fearful, suicidal and even pose a risk to others," Dr. David Healy, director of the department at the University, said in the study.

Healy said that between five and 10 percent of people who take Prozac can be affected by akathisia, a condition where they become mentally restless and lose all inhibitions.

"People don't care about the consequences as you'd normally expect. They're not bothered about contemplating something they would usually be scared of," Healy said.

The study came as a blow to Lilly and contributed to the company's startling losses over the past year. Lilly, however, has still not admitted that violent behavior is in any way linked to the drug.

"Eli Lilly is legally trapped. They might like to admit that Prozac causes violence, but they could open themselves up to all sorts of claims," Healy said.

Not only has the study signaled the end of the Lilly monopoly on anti-depressants, but it has also meant that patients have rediscovered a more traditional treatment -- the therapist's couch.

Some experts warn that a drugs-only approach to treatment reduces self-esteem by assigning minimal importance to such factors as human will, contact and communication. But until now, psychotherapy has taken a backseat to medication in treating mental illness.

The issue of cost-effectiveness is often a defining one for patients, especially since a visit to a medical doctor is reimbursed more fully than one to a therapist. More employers and insurers see anti-depressants, which cost about $90 a month, as better investments than long-term, more costly therapy.

A recent study released by William Danton and David Antonuccio of the University of Nevada School of Medicine compiled data comparing the use of drugs to psychotherapy in treating depression.

"What we concluded is psychotherapy is just as effective as drug treatments for depression and has some advantages in terms of preventing relapse," Antonuccio said in an interview with CNN.

The study recommended strongly that psychotherapy, notably cognitive"behavioral intervention or interpersonal psychotherapy, should be considered the treatment of first choice for depression primarily because of superior long-term outcome and fewer medical risks than drugs.

Though the pill may be necessary to treat certain mental illnesses, the study found, a pill alone is often not enough.

Some say the media is partly to blame for the Prozac bonanza.

By naming Prozac "Drug of the Year" on the cover of Time Magazine, popular culture "distorts and exaggerates [Lilly's] findings, enlisting them to prop up a simplistic biological materialism that claims brain research will reveal everything there is to know about being human," said Joseph Ledoux, professor at New York University's Center for Neural Science.