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In praise of Prozac Health: After a decade of use in America, the drug has become a mainstay in the treatment of depression.

THE BALTIMORE SUN

Christmas Eve 1993: Barbara Barclay, who is jobless, receives bad news in the mail. Sobbing, she rides to her sister's house.

Her sister, who has heard Barbara weep almost daily for the past six months, says, "You should take this." She holds out a green-and-cream capsule.

"I remember looking at it and thinking, 'It can't be this easy; something this small can't take care of something so big,' " she said.

Nov. 3, 1998: Barbara is sitting at her dining-room table in Cypress, Calif. The only thing blue about her is her appearance - blue jeans, bright blue eyes, blue nails. She's writing a book about her rebirth.

"I've never been happier," she said. "It's like the world was in black and white and now it's in Technicolor."

Barbara's story could be repeated by thousands. On the 10th anniversary of its arrival in American medicine cabinets, the once-scary antidepressant Prozac has become respectable. Almost ho-hum. It's no longer shocking to discover your neighbor takes it. You probably know several co-workers who have tried it as well.

Last year alone, doctors wrote nearly 22.8 million Prozac prescriptions, including refills - double the number they wrote in 1993.

Prozac humor is a mainstay of office and home life, an inside joke the entire country gets. Ever hear your boss say she's going to add Prozac to the water cooler? T-shirts proclaim "It's Another Prozac Day." Web surfers visit the electronic museum of Prozac Pez dispensers.

But underneath the winks and smirks is a country that has been changed, some would say dramatically, since Prozac appeared in 1988. Changed by a $2 pill.

It has altered psychiatrists' notions of personality. How can someone be naturally and immutably angry if popping a pill twice a day calms them?

Prozac also has coaxed people out of the depression closet. Since there's a medication that helps them by altering their brain chemistry, depressed people are more secure in the belief that what they have is an illness - not weak character.

Hard-bitten types like Mike Wallace and Art Buchwald have told the world they're on anti-depressants. This fall, 60 readers responded to a California newspaper's request for stories from longtime Prozac users - and they didn't mind having their names published in the newspaper.

"When I'm taking Prozac, I can get news of a death in the family, I can get into an auto accident or I can come out to find someone has hit my car in the parking lot and I deal with it - rationally," 51-year-old Mike Mitchell told the Orange County Register. "When I'm off of it, an event like that would be like an asteroid hitting L.A. There would be no meaning to my life. No reason to go on."

Americans were so afraid of Prozac at the start of the decade that the federal government considered banning it.

Eli Lilly, the Indiana company that makes the drug, was fighting off lawsuits left and right. One blamed Prozac for a Kentucky man's violent rampage that killed seven, then himself. Another claimed the drug drove a 20-year-old San Diego woman to fatally shoot herself.

Families told story after gruesome story to an FDA Prozac panel - but the fears never materialized.

After lengthy studies, said Dr. Jerrold Rosenbaum, associate chief of psychiatry at Massachusetts General Hospital in Boston, patients taking placebos actually thought about and attempted suicide more often than those taking Prozac.

Eli Lilly says "the Prozac defense" has been pleaded in 73 criminal cases and failed every time.

"When people looked at it systematically, they couldn't find any evidence that the drug was making people suicidal or violent," Rosenbaum said.

"Once I cried because my mileage was up to 70,000 and I was going to have to buy another car. Everything was a major devastation. I was always negative and always exhausted.

"The psychiatrist said, 'You know, we could spend the next year or two in sessions trying to get over your hang-ups about money. But I think this drug is going to do as much for you in a shorter period of time with a lot less hassle.' "

- Barbara Sawyer, 60

In his well-read 1993 memoir, "Listening to Prozac," Dr. Peter Kramer writes that he saw patient after patient become "better than well."

"Prozac seemed to give social confidence to the habitually timid, to make the sensitive brash, to lend the introvert the social skills of a salesman."

Psychiatrists have long seen patients who are painfully shy, extremely sensitive, easily angered, chronically negative or just plain fragile. But these are problems they never would have treated with a drug in pre-Prozac days.

"We'd have said it's part of their personality, and it can't be changed," said Dr. Barry Chaitin, department of psychiatry co-chairman at the University of California, Irvine. "Prozac has allowed us to be a little more enthusiastic and aggressive without putting a diagnostic label on it."

It doesn't just treat depression but normalizes patients with a host of other problems - eating disorders, serious anxiety, panic attacks, phobias, obsessive-compulsive disorder and chronic pain.

Will it make you better than well? Not if you're not sick, Rosenbaum said. "Can you get a better temperature if you take aspirin? Only if your temperature is high."

The days of weekly talk therapy are fading - unless you pay for it yourself. Medication visits are 15 minutes. And if a patient is relatively stable, they come along only every couple of months.

"Before, he lived in a robe. He wouldn't wash a dish, or shave. He wouldn't go for a walk. He used a lot of foul language. This went on for two or three years. We were going to kick him out. Prozac just brought him back to life. He wants to wash windows and rake leaves to earn money. He cut his hair. I asked the doctors how long can he take this, because I'm worried about his liver. The pharmacist said he can take it the rest of his life."

- Zenia Hunter, writing about her son John, who has a brain injury

Prozac doesn't work for everybody. In fact, it's no more effective than older anti-depressants. Seventy percent to 80 percent of people who take antidepressants improve to some degree. About half improve 70 percent to 80 percent on the standard depression rating scale, a state called remission. However, a certain number must increase their dose or change to another serotonin-regulating drug, such as Paxil or Zoloft.

It's just that Prozac is so easy to take compared with the older drugs. They caused heart problems, and the most effective dose was often dangerously close to the lethal dose. Prozac makes patients nauseated and gives them headaches during the initial two weeks, but the only lasting side effect appears to be sexual dysfunction.

Twenty-five percent to 30 percent of Chaitin's patients experience sexual dysfunction.This problem may be the crack in Prozac's armor. Drug companies are spending millions to develop drugs with fewer side effects.

When Prozac users, an almost evangelical bunch, hear about new drugs on the horizon, it's clear there are limits to their brand loyalty. As Barclay put it:

"I'm on Prozac forever - or until they come out with something better."

NUMBER OF PRESCRIPTIONS PLACED

1997: 22,776,000

1988: 2,469,000

Source: IMS

Pub Date: 12/20/98

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