Prozac

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I was in my specialty training when I read Peter D.Kramer’s “Listening to Prozac.”

I remember thinking he was articulate and observant and all kinds of wonderful things, riding the cusp of a great change in psychiatry, doubting him to be a “real” scientist who would hang out at a meeting of the Society for Biological Psychiatry as I once did.

I was wondering what to do with the result of his observation that certain character traits, such as “rejection sensitivity,” could be somehow changed for the better with psycho-pharmacology. Read more on “Listening to Prozac” and What People Really Want…

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Whitney Houston’s death might be “old news” already, but I still think her death may not have been in vain.

Because Whitney was a star, we were treated to hearsay before facts.  She drank in the morning, in a public place, and according to some observers may have been behaving a bit strangely.

There is an old screener for alcoholism called the “CAGE” questionnaire.  It’s named after the four questions that presumably even a primary care physician — who has little room left in an overtaxed memory — could remember. Read more on Whitney Houston’s Death May Not Have Been in Vain…

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California is known as “The Golden State” and some have called it “The Land of Milk and Honey.”

The Beverly Hillbillies noted that it was the home of “Swimming pools – Movie stars.”

That should be encouraging for people like my 27 year old, freckled, red-headed patient.   After all, he had a pool cleaning business. But he was nervous — really nervous.

He did not have full-blown panic attacks, though he certainly fit the criteria for generalized anxiety attacks. Sometimes he did get a “heart in the throat” kind of feeling; something which some people would have called a “truncated anxiety attack.” But he had a lot of them and they really didn’t cramp his style very much.

He did not sleep very well, confessed that concentration was poor, and had great difficulty trying to find any interest in collegiate academics. As a result, his grades suffered considerably. And while I could potentially chalk this up to him falling into a category of males who may be better equipped for trade school than an actual 4-year college (based on patience; not necessarily intelligence), I didn’t believe this to be his case at all.

This guy was anxious. Read more on Stuck On The Treatment Treadmill…

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If there is one time to get scared, it is when  a drug company, a government agency, a popular magazine article or – heaven forbid – your doctor says a metabolite is “better” than the drug it came from.

A metabolite is the substance that is left after the body breaks down (metabolizes) a medication.
  
Everyone in this picture know that oxycontin — read “morphine” — has lots of addiction-type problems.  Synthesized by the Germans in 1914, it has been around for quite a while, although not terribly commercially exploited until the folks at Endo Pharmaceutical started pushing it. Read more on Pain Killers Can Be A Prescription For Disaster…

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Number 5 in the USA Today catalog of medical changes in the past 25 years is (imagine a drum roll playing – and CYMBAL CRASH!) — antidepressants are the most popular drugs. Read more on Antidepressants Are Popular — And Dangerous…

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The next person to see me made a dramatic entrance. First, she had gotten a head start on her crying in the waiting room. But more than the sound of her crying and sobbing, she could barely make it through the waiting room door. I am no good at guessing someone’s weight.  She later admitted to being 380 pounds.  I took her word, as our clinic’s scale only went to 300. Her general appearance was that she was swollen with water – a human sponge.  The edema bloated every part of her body, and her crying eyes were nearly swollen shut. I started by asking her when her problems began.  She was now 42, and said she had thought everything was okay until age 15, when she had been raped by a “friend of the family.” This man was not really a friend, he was a person who went to the same church.  Moreover, he was a Sunday school teacher.  You would think that by now everyone would know that being a Sunday school teacher does not make someone a saint.  But this family had not yet figured it out. In many such cases, this type of person is shielded by the religious community, and even the victim’s parents are often in denial.  This woman was lucky. Her parents told her that they were going to prosecute this sinner to the extent of the law.

There was a trial, and she had testified.  She thought everything had turned out great, and so did her parents. The rapist was convicted and sent to jail. Again, those who are experienced in these things know that this type of trauma is never over quite so easily. The woman went on with her life and ended up in a really abusive relationship — the kind where someone locks you up and won’t let you leave the house and beats you if you look out the window.  By the time she got the courage to escape this living hell and seek a shelter, had a peck of kids. They lived in this shelter for over a year before she found that she had what it takes to start over.  She went to school, gained some clerical skills, and started over. She was actually doing pretty well until something happened that triggered a demon she didn’t know had possessed her. She was called for jury duty and went, with pride, wanting to do her civic duty.  She couldn’t.  She had a panic attack as soon as she entered the courtroom.  She ran to the ladies’ room, threw up, and tried to enter the courtroom again – and it was even worse. People thought she was having a heart attack, and they sent an ambulance for her.  I do not recommend this means of getting out of jury duty, although it sure worked for her. Read more on Murphy’s Law Of Medicine At Work…

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People may look at the complex before they look at the obvious — which is a faster answer and closer to the truth. I happened to be talking and I found three more yesterday. Women.  Young, intelligent, and attractive women, who did not have and did not want boyfriends. All three were part of the mental health treatment establishment.

Men losing interest

Men are losing interest in sex

The first time I discovered one of those was some years ago, a few cities ago, and she was a very clever and very talented psychiatric nurse.  She loved her profession, and took good care of people.  She loved nature and animals and plants.  I believe her to have been quite attractive.  She had been turning down dates because she would rather go to her gardening clubs or whatever.

She had also said, without tears or depression, that she expected she would always be alone, would move into the home for old nurses when she was old enough, and die there. She had been on Prozac for about three years. There were a few problems with this. First, nobody had ever talked to her about getting OFF Prozac.  They said she might as well stay on it, since life was that good.

Actually, I have looked at data for depressed folks of varying ages. Sure, there is a risk of side effects, but nobody seems to care.  I cannot remember, off the top of my head, seeing data about the recurrence of depression that suggested anybody needed to stay on antidepressants permanently.

Certainly, nobody under, say, 55 or so.  And she was plenty under.  I mean, there are things you can do to lessen the chance of recurrent depression — psychotherapy, even reading books. And there is the whole question of getting someone off SSRIs.  I have had patients who claim it is impossible.  I’ve had people come to me because the withdrawal effects were horrendous.  Yet I have taken people off easily and (reasonably) quickly with natural substance regimens. It’s not impossible – you just have to know how.

That eliminates many of my colleagues.  Or perhaps they keep their patients on prescription drugs to insure their return and a steady cash-flow.  Naw – doctors wouldn’t do THAT!

There is another problem.  There are drug side effects we know little about or may find hard to measure.  I remember from my days doing clinical trials that at one time, shortly before I left the business, someone adopted a “uniform” side effect reporting system. The trouble with that was trying to fill in the blanks for the questions on the form when the patient is saying things that do not fit in the blanks.

Every one of these mental health professional women had been put on Prozac when it came out, because of the safety and efficacy.  I remember, collecting data, one of the first people I gave Prozac to during clinical trials before that drug was on the market.  She told me that she “felt like a zombie” and that she missed having the full amplitude of emotional expression.  She missed crying at the movies, something she had genuinely enjoyed.  Said she had a feeling of euphoria afterwards — a feeling of euphoria she really enjoyed. Try fitting that one on a uniform side-effects reporting system.

The three women I met yesterday are unlikely to get off their Prozac. They stood in wide-eyed disbelief of my assertions.  Of course, they had just met me and know little about who I really am.  Besides, people seem to have trouble taking advice for which they aren’t paying.  I just reminded them as I remind patients that taking any medication is a choice, and reporting what is going on to a doctor is always a good idea.

If any of these intelligent and well-insured women had gone to a therapist, they could have ended up with some kind of verbally analytic procedure, which obviously would not help.  Or maybe they would be referred for some hormone supplementation, which has biologic risks of its own.  Big ones, like — cancer.

Worse yet, I’ve met two psychiatrists in my 30 years of practice who gave everybody electric shock treatment. Everybody! The first person in whom I suspected a real lack of sex interest had changed her life — the psychiatric nurse — did finally get off her Prozac. If she had any recurrent depression problems, I do not know about them.

She had a date within two weeks, and last I heard, was dating many interesting men, looking for a best boyfriend.

I am convinced that we are looking at a Prozac side effect that the system has made it impossible to measure.  We probably have at least a little of the same side effect with similar drugs in the same class – such as Paxil and Zoloft.  Maybe others, too.

The psychiatric nurse easily agreed her general quality of life had been diminished while she was on Prozac.  She was too undepressed to notice.  When she got off the drug, she suddenly noticed.

Getting a drug past the FDA takes some studies on how it gets into the body and the like.  Nobody ever seems very worried about getting off a psychiatric drug.  That’s been the focus of my private practice for at least the past five or six years.

For the individual, the effect is pretty evident even though I only have one clear cut example. What about the species?  Is this just one of several steps driving humans to …. extinction? People change as time passes.  What affected you in the past may have gone away – as many illnesses seem to do.

Spending your lifetime on a drug when you no longer need it is tragic.  Or having your quality of life changed because of the way a drug reacts in your body – instead of seeking alternatives to control your problems.

I think it is worthwhile for anybody on a psychotropic drug to ask how their life has changed since they have been on a prescription medicine. We researchers have been limited to collecting information on side effects that the FDA and/or drug companies “let” us.

So don’t look toward the government or the drug companies for help.

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Ah, the Midwest, the gracious “heartland” where I spent the hunk of my career when I returned to America from Europe.  I actually spent little time in Wisconsin.  I know more about Milwaukee than I do about Madison, although I suspect there is at least one physician there I helped train and get into some kind of desk job because he seemed to be scared of patients. Response to criticism was not his strong suit, either.  I blocked him out so completely I cannot remember his name now.  I do remember how grateful he was that I had figured out something that sounded good to put on his letter of recommendation for this public health type desk job.  I had asked everybody in the department for advice on how to word it.  “Is at his best dealing with patients earlier in the process of developing illness” is something like what I came up with.

Although regional generalizations are by definition rather superficial, I suspect that the mentality in Wisconsin is more similar to Kansas or Ohio than it is different.  The true colorful eccentrics — not grossly pathological, but eccentric — seem to be found in the Midwestern United States the way in France, they were found in the smaller, even semi-rural towns.  I remember the writer Richepin wrote things about such eccentrics that I loved.  He is hard to find in English, but there is at least one link. Read more on Touchy Musician: Everybody’s A Critic…

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“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. Read more on “Just gimme the Prozac!”…

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