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Subject: Big Suprise
Date: 17 Jul 1995 17:10:42 +0200
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The pill that's easy to swallow; 10,000,000 Americans still taking Prozac
Thursday, July 13, 1995
By Bonnie Bing
It's been called "the personality pill" and "the perfect drug," and it's
been the subject of jokes and criticism.
Prozac, the drug that hit the market in 1987, has been debated and widely
distributed. And while the number of prescriptions is slowing, it's still
a very popular drug. Ten million people in the United States and 5 million
others worldwide are taking it.
Is its popularity deserved?
"It's not the miracle drug or the villain it's been portrayed to be," said
Elsie Steelberg, a Wichita psychiatrist. "I've heard it described as the
Valium of the '90s."
Regardless of what you call it, Prozac seems to have a new use every week.
It's not just for depression anymore. It's now being marketed by Eli Lilly
and Co. for obsessive-compulsive disorder and for bulimia. It's being
tested along with similar drugs to treat an expanding list of maladies
such as panic disorder, social phobias, obsessive hair-pulling, autism,
premenstrual syndrome, chronic fatigue syndrome and compulsive gambling.
How can one little green-and-beige capsule do so much?
Prozac was the first of a class of drugs called selective serotonin
reuptake inhibitors, or SSRIs.
Serotonin is a chemical thought to govern moods. It also is a
neurotransmitter, which means it carries messages from one nerve cell in
the brain to another across a space called a synapse. The serotonin leaves
the sending nerve cell, enters the synapse, then either binds to the
receptors on the receiving cell or is taken back up by the sending cell.
SSRIs block the reuptake of the serotonin into the sending cell, boosting
the concentration of serotonin in the synapses. This concentration
increases the availability of serotonin at the critically important brain
receptor sites, thought to result in normal nervous system transmission,
and this results in a feeling of well-being.
Prozac and the other SSRIs are highly specific in blocking the uptake only
of serotonin and not other neurotransmitters; that's why they are known as
selective serotonin reuptake inhibitors. Obviously, then, it's an option
for treating depression.
Many people tie their depression to their weight problem. In a time when
weight loss without pain or strain is at a premium, it's not surprising
Lilly and Co. submitted a high-dosage version of Prozac to the Food and
Drug Administration for approval in treating obesity. The company withdrew
the request early this year, however, citing regulatory and financial
But that doesn't mean Prozac is not considered helpful in weight loss.
"There is a new use for Prozac the big thing that came out about three
months ago using it with Ionamin or Pondimin. You use Prozac with one of
these two, or even a combination of all three for weight loss," said
Robert Bettis of Edmonds, Wash., a family practitioner who was in Wichita
Pondimin is the brand name for fenfluramine, an appetite suppressant that
works on serotonin. Ionamin, along with Fastin, are brand names for
phentermine, an appetite suppressant that works on dopamine, a brain
chemical. Both drugs have been around since the 1970s.
Bettis has a patient who took Prozac and Ionamine and lost 50 pounds in
three months. "She lost the weight without making a big effort. She has
struggled with her weight for years, and she said the pounds seemed to
drop off," he said. "I'd say she was 70-80 pounds overweight."
He said he has patients bringing him articles nearly every day with
information on using the combination of drugs to lose weight. "Now,
whether it would work for everyone, I don't know," he said, "but it
appears that these combinations would work and be safe for weight loss."
Bettis said he is prescribing Prozac for depression, but not as often as
he did when it first came out. "I usually use Zoloft now, because first of
all it's not as controversial due to media attention given to Prozac," he
In the first years after Prozac entered the market in 1987, critics
claimed that it was being over prescribed or used without careful
consideration to each patient's needs.
Then in November 1989, an attack against Prozac was launched by the Church
of Scientology, with spokesmen alleging Prozac to be a "killer drug."
Leading the attack was the Citizens Commission on Human Rights, which
lobbied against the drug and as ammunition used an article published in
February 1990 in the American Journal of Psychiatry. In the article,
several Boston psychiatrists reported that after two to seven weeks on
Prozac, six out of 172 high-risk mental patients who had not been
responsive to other drugs became preoccupied with violent, obsessive,
suicidal thought, and that two of them tried unsuccessfully to kill
In his book "Prozac," physician Ronald R. Fieve explains, "Nothing about
these cases was in the least extraordinary to psychiatrists who are
familiar with and treat depression. Depressed people are often suicidal:
it's a symptom of the disease. In addition, four of the six of those
patients were taking other medications and in one case five other
But fans and naysayers agreed that because serotonin, the neurotransmitter
Prozac specifically affects, may be linked with aggression, there was
reason for concern. It was speculated that in a few instances Prozac might
tip the balance in the wrong direction, toward violence and aggression.
As of January 1994, 78 suits against Eli Lilly had been dismissed and 160
others filed with accusations ranging from charges that Prozac causes
rashes to allegations that the drug led to violent, bizarre death.
Presently, countless people in the medical field have found it useful, but
overall, the number of prescriptions has decreased, some say because the
cost is prohibitive. A month's worth of Prozac costs about $60 for a
20-milligram pill taken once a day.
Financial considerations aside, when Prozac is taken, regardless of the
reason, there may be side effects, especially nausea, but also headaches,
drowsiness, loss of sexual desire, nervousness, anxiety, insomnia,
diarrhea, dry mouth, sweating, tremor and rashes.
But many patients on Prozac say they are happy to pay the price, both at
the cash register and in terms of a short-term side effect.
A 46-year-old Wichita businessman and artist says that after being on
Prozac for 1 1/2 years he's a lot calmer than he's been in years. "After
six months I noticed I had more good days and I could think through things
easier because I wasn't so busy worrying about things," he said. "It helps
level you out, and you look at every day as a level playing field."
Does he plan to take Prozac forever? "I haven't thought about it that
much," he said. "My days are good. I'm not messin' with it. I'm going to
take it and keep my mouth shut."
A 53-year-old Wichita woman says that since taking Prozac she can get
through the day "without crying or having a temper tantrum. It makes me
more focused. And if there is a task to do, I can attack it with a
She says her perspective has improved even though the difficult
circumstances at her job haven't changed. "Things I thought were critical
no longer seem like life and death. I don't know if it's changed my value
system, but I think it has made me a kinder person," she said.
"It even kind of helps control weight and I sleep like a baby. It hasn't
bothered my sex life, either. I am more loving. My husband doesn't want me
to get off it. I know I'll be on it until things at work change."
With so much media exposure, Prozac quickly became a well-known drug and
one that some people say they are embarrassed to disclose they're taking.
Some say they were embarrassed to go to the doctor for depression in the
"I think depression has been tremendously under recognized by physicians
and under treated also," Bettis said. "People who come in and say they're
feeling down have usually suffered for years before they ever go to the
doctor. Some of these people can turn their lives around in a short time
Bettis points out, as many other doctors have done, that some patients on
Prozac feel better right away, simply because they have taken a step to
get help with their depression.
Some might feel better right away, but they're not always anxious to
explain to friends and family why they feel better. "I think I was
embarrassed when I first starting taking it because there were so many
stories about how doctors were too liberal in prescribing it," said a
48-year-old Wichita woman.
"It took almost two months before I could tell a difference and longer
than that before I told people I was taking it." Headaches were a side
effect before her dosage was cut back. After a year she's cutting back
again, to taking Prozac every other day.
She's clearly among the fans of Prozac.
"I love it for helping me see how good life can be," she said. "I don't
think I could have gotten to this place with any amount of counseling."