Selective serotonin reuptake inhibitors
Perhaps more than any prescription medication in history, Prozac has had a profound impact, not only on the patients who have taken it, but on the very practice of psychiatry, and on popular conceptions of mood and personality as well. Within three years of its release in 1987, Prozac (fluoxetine hydrochloride) had become the drug most prescribed by psychiatrists in the United States; by 1994 it was the second-best-selling drug of any kind in the world, with a reported one billion prescriptions written per month. In A History of Psychiatry: From the Era of the Asylum to the Age of Prozac, Edward Shorter describes Prozac as the household word of the 1990s; in 1994, Newsweek proclaimed that Prozac had attained the familiarity of Kleenex and the social status of springwater. The drug has been the subject of numerous television programs, magazine articles, and psychology and self-help books. Much more than a medication, Prozac has come to represent the angst and antidote of a generation, as described in Elizabeth Wurtzel's 1994 best-seller, Prozac Nation; and with millions of people taking Prozac each year, and its benefits being touted in the media and discussed at cocktail parties, this new-generation antidepressant arguably has contributed to the destigmatization of mental illness.
Released in December 1987 by the Eli Lilly Company, Prozac was the first in a new class of antidepressant medications: the selective serotonin reuptake inhibitors. The SSRIs are "designer drugs," highly potent chemical compounds that selectively affect a single biological process and, by extension, target a highly specified physiological function. In the case of Prozac (and the other SSRIs, such as Zoloft and Paxil), the target is the brain's reuptake of the neurotransmitter serotonin (5-HT), which is involved in the regulation of mood. By increasing the levels of serotonin available to the brain, Prozac has been found to enhance not only mood, but also energy, assertiveness, and optimism; along with treating anxiety, panic attacks, social discomfort, rejection-sensitivity, and obsessive thoughts. Thus, the effect of Prozac goes beyond the relief of clinical depression: for many people, Prozac ultimately improves one's self-concept.
While earlier antidepressants—such as the tricyclics and monoamine oxidase inhibitors—were effective in controlling depressive symptoms, they were less selective in their action, making them cumbersome to use and difficult to monitor. Tricyclics, which are highly effective in controlling "classical" depression characterized by insomnia, loss of appetite, low mood, and low energy, also interfere with the neurotransmitter acetylcholine, triggering side effects associated with the "flight or fight" response: rapid heart rate, sweating, dry mouth, constipation, and urinary retention. The MAOIs, which effectively alleviate the "nonclassical" depressions that aren't helped by tricyclics, are less "dirty" but more problematic because of their potentially fatal interactions with many foods.
In clinical trials, Prozac has proven to be as effective in treating classical depression as the tricyclics and, for many patients, even more effective in alleviating nonclassical depression than the MAOIs. Because its action is so specific, it is difficult to overdose on Prozac, and doing so does not pose major risk of death. Most significantly, Prozac is "clean": it works without the sedative effects, weight gain, and dangerous interactions associated with the other antidepressant medications. Prozac's tendencies to increase energy and decrease appetite are both highly desirable and supremely marketable traits that have contributed much to its popularity.
Yet, despite the clinical evidence supporting Prozac's marketing as a safe and virtually side-effect-free drug, its initial release was marred by sensational reports of patients "going crazy" on Prozac: some purportedly becoming suicidal for the first time, others claiming to experience episodes of violent behaviors—including murder—triggered by the medication. In 1989, an attorney filed a series of lawsuits against the Eli Lilly Company following an incident in which a man who had taken Prozac (along with several other medications), killed eight people, wounded twelve, and then killed himself. This story was featured on Donahue (in a show provocatively titled "Prozac: Medication That Makes You Kill"), and a similar story was featured on Larry King Live in 1991, but neither case held up in court. In the end, the claims that Prozac created dangerous behavior in patients who previously had no history of suicide or violence subsided. The sensational headlines soon gave way to a general acceptance of Prozac as a drug safe enough for patients with severe depression and "clean" enough to appeal to a more general public seeking relief from mild dysphoria.
This use of medication to enhance personality in the absence of significant mental illness—a practice that Peter Kramer has called "cosmetic pharmacology"—has been a boon for drug manufacturers and a red flag for naturalists and ethicists. While Time hailed the use of Prozac for personality improvement as "a medical breakthrough," others have decried the use of pharmaceuticals to enhance socially desirable traits as a triumph of consumer culture over rational science and an alarming example of social Darwinism. Those concerned about the ethical implications of Prozac argue that, by enabling people who are not clinically depressed to brighten their mood and improve their personalities, Prozac may contribute to a lowering of our cultural tolerance for pessimism, grief, and other manifestations of dysphoria. On the other hand, some have argued that a positive byproduct of the widespread popularity of Prozac may be a narrowing of the gap between the so-called "normal" population and the "mentally ill."
"The Culture of Prozac." Newsweek. February 7, 1994, 41.
Elfenbein, Debra, editor. Living with Prozac. San Francisco, Harper, 1995.
Kramer, Peter. Listening to Prozac. New York, Viking, 1993.
"The Personality Pill," Time. October 1, 1993, 53.
Shorter, Edward. A History of Psychiatry: From the Era of the Asylum to the Age of Prozac. New York, John Wiley & Sons, 1997.
Wurtzel, Elizabeth. Prozac Nation. Boston, Houghton Mifflin, 1994.
The drug Prozac was introduced in 1987. By 1990, psychiatrists in the United States prescribed Prozac more often than any other drug. Five years later, its maker, Eli Lilly and Co., reported sales of over $2 billion. Originally designed as an anti-depressant, Prozac has since been used to combat obesity, shyness, obsessive-compulsive behavior, and even back pain. It improves mood, energy levels, optimism, and feelings of inadequacy. Not only has Prozac helped millions of people deal with their emotional and psychological problems, but it has changed their understanding of moods and personality.
Prozac is one of a group of "designer" drugs known as Selective Serotonin Reuptake Inhibitors (SSRIs). These drugs work by increasing levels of the chemical serotonin (seh-reh-TOE-nin) in the brain. Older antidepressants are less specific. They change the balance of a number of brain chemicals in the hope that one of them will have the desired effect. In theory, this makes Prozac much safer and easier to monitor. In the early 1990s, however, Prozac was linked with a number of disturbing events. There were reports of people becoming violent or suicidal for the first time while taking Prozac. Several lawsuits tried and failed to link SSRIs with gun massacres and other violent acts. In 2001, Prozac is generally considered a safe and useful drug therapy. The safety of the drug has allowed some people who are not clinically depressed to indulge in "cosmetic pharmacology." In other words. they take Prozac simply to "improve" their personalities.
Aside from its impact on psychiatry, during the 1990s, Prozac became a symbol of the "stressed-out" nature of American life. More than any other medicine, it is seen as a cure for the stresses and strains of modern life. Perhaps the most significant side effect of Prozac has been on society itself. Critics fear that the use of Prozac as cosmetic pharmacology devalues the suffering involved in real mental illness. More positively, the widespread use of Prozac may also make society more tolerant and open about mental-health problems.
For More Information
Appleton, William S. Prozac and the New Antidepressants: What YouNeed to Know About Prozac, Zoloft, Paxil, Luvox, Wellbutrin, Effexor, Serzone, Vestra, Celexa, St. John's Wort and Others. New York: Plume, 2000.
Prozac.com.http://www.prozac.com/ (accessed April 4, 2002).
Kramer, Peter. Listening to Prozac. New York: Viking, 1993.
National Alliance for the Mentally Ill. "Prozac." NAMI: The Nation's Voice on Mental Illness.http://www.nami.org/helpline/prozac.htm (accessed April 4, 2002).
Wurtzel, Elizabeth. Prozac Nation. Boston: Houghton Mifflin, 1994.
PROZAC (or fluoxetine) was the first of a class of drugs known as selective serotonin reuptake inhibitors (SSRI) to be introduced for the treatment of depression and other psychological disorders. These drugs work by increasing the amount of serotonin, a neurotransmitter thought to be involved in the biochemical mechanism of depression, available in the brain. Researchers hoped that because these drugs specifically targeted serotonin without affecting other neurotransmitters, they would have fewer undesirable side effects than earlier generations of psychiatric drugs.
First introduced in Belgium by the Eli Lilly Company in 1986, Prozac was made available in the United States the following year. It enjoyed remarkable early success—within five years, 4.5 million Americans had taken Prozac. Although the Food and Drug Administration had only approved the drug to be prescribed for depression and obsessive-compulsive disorder, it soon became common for physicians and psychiatrists to prescribe Prozac for eating, anxiety, and panic disorders and posttraumatic stress as well.
With this rapid acceptance, Prozac became a cultural phenomenon. Patients using Prozac reported feeling beyond well, suggesting that the drug had not only eased their depression but had also led them to new levels of awareness of their personalities. Prozac users reported the loss of social inhibitions: the shy became bolder, the lazy more diligent, the cautious more confident. For the first time, a drug seemed as if it might be able to improve personalities and suggested a future where pharmaceuticals could allow patients to reshape themselves to meet social expectations.
Although usage of Prozac and related drugs remained high in the late 1990s (an estimated 40 million patients worldwide were treated with Prozac during its first fifteen years on the market), a cultural backlash did arise against its early success. Some patients claimed that the drug made them feel suicidal. Others made even darker claims, suggesting that Prozac led them to commit murder and other crimes. Popular belief that Prozac could perfect otherwise normal personalities waned, but the use of the drug did not.
Kramer, Peter D. Listening to Prozac. New York: Penguin, 1997.
Wurtzel, Elizabeth. Prozac Nation: Young & Depressed in America. New York: Riverhead Books. 1995.
See alsoMental Illness .