If Everyone Were On Prozac ......

By: Sanjay Gupia, M.D.

W hen Proxac arrived in the U.S. in 1987, with its catchy, computer-generated name and massive marketing campaign, it didn’t just take over the market for anti-depressants; it expanded that market many times over, quickly becoming one of the world’s best-selling drugs. Although originally approved only for adults with “symptoms of depression illness,”Prozac and its imitators (Zoloft, Paxil, Celexa, Luvox) are take today by millions of patients----including more and more children–who don’t necessarily meet the textbook criteria for clinical depression. Veterinarians have even made Prozac their N. 1 choice for dogs with the blues. Prozac and the other so-called SSRIs have been a breakthrough on several levels. Compared with first-generation anti-depressants, they are remarkably effective and relatively free of serious side effects. They work by slowing the brain’s absorption of the mood-enhancing neurotransmitter serotonin (thus the term selective serotonin reuptake inhibitor).

What makes serotonin such an important brain chemical is that it affects everybody, not only depressives. According to Dr. Jonathan Metzi, author of Proc on the Couch, if you were to go on the drug today, there is a very good chance that you would feel better, even though you aren’t depressed. Dr. Peter Kramer, author of Listening to Prozac. Describes the effect as feeling “better than well.” And, Now, that raises an intriguing question about the future of mood-altering pharmaceuticals: IF prozac can make you feel better EVEN if you are not depressed WHY shouldn’t we all be taking it?

Is that the direction we’re going, as the drugs become more socially acceptable and more heavily marketed? (More than 11 million Americans already take some form of antidepressant now) It’s a question that arises only because SSRIs are relatively mild and subtle medications. There are a great plenty drugs that can make you feel better, at least temporarily-----acohol and heroin come immediately to mind----but they tend to be addictive or toxic or both. Prozac is neither.

The drug does have its risks. According to several recent clinical studies, Prozac is associated with insomnia, restlessness, nausea, weakness, loss of appetite and also tremors. Also, for up to 60% of all users, Prozac will interfere with their sex drive. Given indiscriminately to manic-depressives, it can trigger serious manic episodes.

And there is serious anecdotal evidence linking Prozac with suicide and other violent behavior, although Prozac or the underlying depression is to blame is still an ope question as of today.

But, what if antidepressants like Prozac were one day shortly made completely free of all side effects and served only to elevate mood? Do you supposed there would be any objection to prescribing them to the entire nation/world?

Every psychiatrist I spoke with still answered “probably.” Some see SSRIs as a kind of mental shortcut that relieves patients of the need to work through their problems. Still, others fear that a nation on Proxac would miss the inherent value of struggle and strife. Dr. Kramer think there may be an intrinsic virtue in what he calls the “unmodified personality.” Although this month the FDA approved Prozac for treating children and adolescents ages 7 to 14, Dr. Jerry Rushton, a pediatrician at the University of Michigan, bemoans it use for kids, fearing it may interfere with their natural emotional development.

Maybe, that is something we should all worry about. It doesn’t take anything away from the good that modern depressants have done for the clinically depressed to say that if what we are seeking is something of real and lasting value, we will probably never find it in a pill. Never have yet!

Source: TIME Special Issue January 20, 2003.

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