Happy Birthday Prozac

Prozac is twenty and The Observer celebrates with an article noting 20 things you may not know about the drug that was supposed to make us ‘better than well’.

Prozac is the brand name for the drug fluoxetine and was so successful that it has become a by-word for antidepressants and psychiatric drug treatment.

Its popularity was partly due to it being a safer alternative to the older tricyclic antidepressants, such as amitriptyline, and the addictive benzodiazepine drugs used to treat anxiety, such as Vallium.

Also, it came at a time when depression was becoming destigmatised and more widely recognised. Helped in no small part, of course, by Eli Lilly heavily funding a number ‘public education’ campaigns and depression support groups.

During the 1990s Prozac was truly considered a wonder drug.

Psychiatrist Peter Kramer’s 1994 book Listening to Prozac (ISBN 0140266712) had case studies of people who’s marriages were saved, porn addiction was cured (!) and generally became better, more thoughtful people after taking the drug.

Notably, several of the case studies were not people who were clinically depressed. Kramer wondered whether we would take such drugs to improve on normality rather than to treat pathology, and coined the term ‘cosmetic pharmacology’ for the former.

As the 90s drew to a close, clouds started to form and the sunshine started to fade.

The storm broke in 1998 as court cases focused on the negative effects of Prozac and related drugs and an influential paper was published suggesting the drug wasn’t as effective as it was thought.

Drug company Smithkline was sued by the family of a man who killed himself and his family after taking the related drug paroxetine, also known as Paxil or Seroxat.

The court case involve psychiatrist Dr David Healy who had been investigating the possible role of Prozac in stirring up suicidal thoughts in some depressed patients.

Healy discovered that Eli Lilly had obscured the adverse effects of Prozac from their pre-release drug trials and was subsequently subjected to a dirty tricks campaign by the company.

This became a legal case in itself and he eventually settled for what are thought to be significant out-of-court damages.

Furthermore, an influential paper published by Irving Kirsh and Guy Sapirstein (wittily titled ‘Listening to Prozac but hearing placebo’), analysed a series of antidepressant drug trials and reported that only 25% of the improvement in the patients was due to the drug, the rest, the data suggested, was placebo effect.

Researchers started to challenge the virtually evidence free message that ‘low serotonin causes depression’ on which the marketing campaigns for SSRI drugs relied.

More recently, worries have emerged about Prozac and related drugs increasing suicidal thoughts in some children (again with allegations about drug companies burying negative findings), with antidepressants now carrying a warning on the box to alert doctors and clinicians.

The pendulum has swung back a little since then, with recent studies indicating that while some children will have an increase in suicidal thinking, they are a small minority and, generally, the benefits outweigh the risks in most children.

Current evidence suggests that Prozac is an effective treatment for depression, although it’s not without side-effects and, on balance, is about as effective as most other antidepressants.

Prozac is a useful treatment for depression and anxiety, but is no longer the ‘wonder drug’ it once was – and we’re probably all better off for having a more balanced view.

The Observer article is a guide to the drug and its wide-ranging impact on society, covering everything from its neurochenical effects to its influence on the music scene.

Link to Observer article ‘Eternal sunshine’ (via Furious Seasons).

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