Prozac, the Controversy over Prozac

It began on March 26, 1990 on the cover of Newsweek. The Pill of the Year was not Madonna in Dick Tracy, not Kevin Costner in Dances with Wolves, but a solitary green and white capsule that promised a cure for the human spirit. Not to be outdone, Time countered a few weeks later with a report from the prestigious McLean Hospital of patients who became agitated, assaultive and suicidal on Prozac.

Next, the heavy artillery --- Oprah, Geraldo, and Phil. These scientific savants of sensationalism brought forth survivors of Prozac who testified that, "Prozac made me kill my Mama!" Headlines began to appear in newspapers: "Subway Killer Was On Prozac!!"

Never mind that hundreds of thousands of patients with painful depression were returning to productive lives. Never mind that 99% of those who commit murder are not on Prozac. What kind of headline is that? "Blowtorch Murderer Was Not on Prozac?"

The volleys from the writers began in 1993. Peter Kramer, a psychiatrist from Providence, published Listening to Prozac in 1993. But people heard what they wanted to hear. The hopeless hoped for a cure, and they took Kramer's thoughtful reflections on the usefulness of Prozac (and other drugs like it) in certain clinical situations as a promise that their dreams would come true. The hateful misread Kramer's fear that Prozac would become a panacea for the human condition as a conclusion that Prozac would usher in the age of "cosmetic psychopharmacology," making those who took it as glib and charming as the staff on "The West Wing."

The next salvo came from Peter Breggin, M.D., a psychiatrist who answered, in 1994, with Talking Back to Prozac: What Doctors Aren't Telling You About Today's Most Controversial Drug, a venomous diatribe against the evils of Prozac. (He also came forth with a book in 1998, Talking Back to Ritalin: What Doctors Aren't Telling You About Stimulants for Children.)

A desperate Elizabeth Wurzel (1994) put a finger down her throat and came up with Prozac Nation, a narcissitic ramble down the rabbit hole, bragging like a frat boy of her sexual exploits and drug-induced stupors, and a resurrection through Prozac, as she became the toast of "New York Magazine" and "The New Yorker," until they both let her go after a mercifully brief series of critical reviews.

And now, at last, comes Joseph Glenmullen, M.D., a Harvard psychiatrist who strikes fear into the hearts of lotus eaters. Like Breggin before him, he bases most of his conclusions on individual cases he has seen.

The case history is a time-honored tradition in the teaching and learning of medicine. Most teaching in hospitals takes place at the bedside when the "case" is presented to the senior physician by the lowly intern or medical student. And the ultimate learning experience takes place at the clinico-pathologic conference. A case history is presented to a sage who must undergo a medical auto-da-fé, coming to a diagnosis before an assembled multitude. The coup-de-grace is administered by the pathologist, who reveals the findings of the autopsy that he has just performed on the patient. But coming to a conclusion on the basis of one or two cases, however dramatic the impression they may make, is not a basis for scientific or clinical validity.

I remember well the first psychotic patient that I encountered in my first year of psychiatric residency. In the admitting area, she poured out her vitriol at me, spit flying from her mouth: "Look what I got! A lousy first-year resident! I come to the University Hospital, and I get a fucking first year resident! And look at you! You're a midget! My Charlie is six-feet-six! Do you know what kind of a schlong a man that big has?" I felt the blood draining from my face. My attempts at soothing her rage served only to inflame it. My chief resident strolled by, and with an amused glance, whispered to me, "Give her Mellaril." I ordered Mellaril, 200 mg. I hoped she'd die. Instead, within a day, she was pleasant, apologetic, and coherent.

"It's a miracle," I told my chief. For the next two weeks, every patient I admitted --- old or young, agitated or depressed --- got Mellaril 200 mg. But there were no more miracles. Gradually I began to learn to use other drugs and to tailor them to the needs of the individual patient.

Make no mistake about it --- Glenmullen's purpose is to frighten. On the second page, he says,

In recent years, the danger of long-term side effects has emerged in association with Prozac-type drugs, making it imperative to minimize one's exposure to them. Neurologic disorders including disfiguring facial and whole body tics, indicating potential brain damage, are an increasing concern with patients on the drugs. Withdrawal syndromes-which can be debilitating-are estimated to affect up to 50% of patients.... Sexual dysfunction affects 60% of people. Increasing reports are being made of people becoming dependent on the medications after chronic use... there is evidence that they may effect a "chemical lobotomy" by destroying the nerve endings that they target in the brain... And startling new information on Prozac's precipitating suicidal and violent behavior has come to light.

I, a Harvard graduate, a board-certified psychiatrist with 25 years of experience, a faculty member at the Brown University School of Medicine, tell you that these statements are full of exaggeration and distortion, designed to frighten and not to inform. A number of a psychiatric researchers far more prominent and experienced than I agree. Glenmullen has lined up a host of references in extensive footnotes. He quotes many prominent physicians, among them the writer-surgeon Sherwin Nuland, in support of his position.

And you, poor reader, who do you trust? Who do you believe? My advice: call your local chapter of NAMI (National Alliance for the Mentally Ill), an organization of families of those with psychiatric illness. They don't love psychiatrists and they don't hate them. They owe no allegiance to pharmaceutical companies. They believe in both medication and psychotherapy. They are aware of the controversies about Prozac-like drugs (SSRI). You can also visit their website at

http://www.nami.org

If you must read one of these books, read Kramer's. Whether or not you think his opinions about Prozac are correct, you will agree that he is a wonderful writer. You will not be able to say that about Glenmullen.