“Just gimme the Prozac!”


“Just gimme the Prozac and let me outa here.”

In a clinic where most people were indigent and needed more than twenty clinics could give them (food, shelter, friends, job) this woman was well dressed and snappy.  She looked a little like some petite actress, maybe Holly Hunter, playing a businesswoman.  

In fact, she told me that she was a real estate broker and was not producing enough so that was the proof that she really needed her Prozac.  She had been on it for a while, in steadily increasing doses, and now was on 60 mg.  Over a couple of years, her dose had slowly been raised from the fairly standard 20mg.

It was a treatment for depression.  I had no way — except notes written by previous psychiatrists long-gone — to figure out how depressed she had been when she had actually started on Prozac. And the old notes weren’t much help.

Her idea of depression did not seem quite as bad as some other people’s idea of depression.  Her stable marriage did not seem to have been stressed.  She sounded more like someone who had been producing badly as a real estate broker.  Prozac had somehow helped.

All of this reminded me of a book I had read some time ago, “Listening to Prozac” by Peter Kramer, MD.

To see things in context, the more literate reviews help.  Like this one, too.

The folks at Gray Matters Magazine get more to the core of the issue:

The real question is something called “cosmetic psychopharmacology.” Should we be giving medications to people who are maybe not so sick; maybe not sick at all.  Dr. Kramer appears to have actually listened to patients, something rare in modern psychiatry and for which he is to be commended.  People have told me, too, that they are less sensitive to being rejected by other people when they are taking antidepressants.  But I would not give somebody an antidepressat just for that; not in a world where drugs have side effects we are still discovering, and there are plenty of drug free ways to change whatever it is you don’t like about your life.

After all, I would rather dish out some natural substances that I’ve found to be far safer than prescription drugs. Those who worship pills can find something to satisfy them in that ball part with far less risk.  As for the patient in question, she may have been really depressed at one time. She had no side effects from Prozac whatsoever.  

After assessing the best I could, I did what I do in a pinch.  If I cannot make a perfect decision, I make the decision that is less likely to cause harm.  She received more Prozac, bringing her current dose up to 80 mg., but only after a discussion of advantages and risks — which she claimed she had never heard. I made sure she signed a new “informed consent” paper indicating that she understood what I had told her, and agreeing to go get a blood panel screening particularly for conditions that may mimic depression (diabetes, low thyroid, and others) and getting a general medical checkup.

When Prozac (fluoxetine, in its generic name) came out, it was a revelation.  The first drug in the new class called selective serotonin reuptake inhibitors (SSRIs), replacing Tricyclic antidepressants (TCAs) that could cause serious heart problems or death in overdose, and required regular testing of blood levels for safety.  I still remember the first public announcement of it on the media – it was such a ground-breaking advance in medicine.

Later, I trusted drug manufacturer Eli Lilly less after they claimed that Prozac would un-depress people as well as making them thin (never saw a weight loss over five pounds) and more sexy (it actually diminishes or removes interest in sex for plenty of people).

Here is what I printed out for the woman who got the Prozac.  I remember the Eli Lilly representative who actually fled from the room when I tried to give her a copy.  I told her then as I am telling you now that I have taken people off Prozac for tics, skin problems, and total absence of sex life (although I discovered how to treat that one with herbs, quite effectively).  On a side-note – I’ve had drug reps seek me out and beg me to tell them (in confidence) what natural supplements can overcome the sex-drive-killing side effects of their medicines so they can convince doctors to keep dishing it out to patients.

As an alternative to cosmetic psychopharmacology, I can propose “cosmetic natural substance pharmacology.” Moveover, I can propose non-chemical solutions, like forms of Emotional Freedom Technique  (EFT).  People want so much.  They want on-off switches — to wake up when they want and sleep when they want.  They want their personalities fixed in easy and fast ways without work.  They want instant happy.  Natural substances and non-drug treatments can do a lot of this. People, unfortunately, also seem to want their government to pay for these fixes.  This does make things a little harder.  New remedies are always promised to do things old ones could not, and seem infallible until they are around enough and used enough for us to see their problems.  

This is not a new idea.  I am glad I have been practicing psychiatry long enough to have seen this happen and recognize it when it comes up.

It is not a new phenomenon.  One of my heroes, 19th century British-Canadian physician and physician educator Sir William Osler, said of new remedies, “Use it while it still works.”

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Comments on “Just gimme the Prozac!” Leave a Comment

May 18, 2010

Musan @ 6:02 pm #

Great Post. I’m very interested in natural alternatives to SSRI type drugs like Prozac and Paxil. They actually increase the risk of suicide, which is the thing people taking them are trying to prevent. I’m looking all over for alternatives. From TrueHope to counseling and theories of depression. What’s your answer?

May 19, 2010

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