June 2, 2000 -- "I look so awful, I'm afraid to leave the house!"
Maura, a graceful 39-year-old Irish woman, had been a psychotherapy patient of
mine for about a year when she began developing strange, fluttering tics around
her eyes. The tics eventually grew to include involuntary chewing motions and
twitching of her lips. Her tongue darted in and out uncontrollably. She wore
sunglasses and scarves to cover the disfiguring movements.
What happened to Maura is called "tardive dyskinesia," and
it's one of the most worrisome side effects of many psychiatric drugs
prescribed in America, including Prozac. Maura's primary care physician had put
her on Prozac two years earlier because she'd been feeling anxious and weepy
whenever she drove on highways. A year after that, she became my psychotherapy
patient, and after she successfully completed therapy, we began cutting back on
her Prozac prescription.
You may be surprised to learn that between 3% and 6% of the population is at risk for a serious, potentially life-threatening condition known as double depression. Many of those people can lower that risk. But even after double depression develops, many people delay or avoid getting treatment that could save their lives.
Still, what had started as mild facial tics became uncontrollable symptoms
that confined Maura to her house. It took six months for the worst of these
disfiguring tics to subside. She still has twitching around her lips.
Doctors are now seeing side effects with Prozac indicating a range of loss
of motor control: tics, twitches, muscle spasms, immobilizing fatigue, and
tremors. While this drug is marketed as a panacea, and the public's general
impression is that it brings only incidental side effects, Eli Lilly and Co.'s
(Prozac's manufacturer) official product information acknowledges that tremors
alone occur in 10% of patients on Prozac. (Any side effect occurring in 1% or
more of patients is acknowledged as "frequent" by the pharmaceutical
More than 28 million people have taken Prozac and other related
antidepressant drugs such as Zoloft, Paxil, and Luvox, which are thought to
increase levels of serotonin, a chemical messenger in the body associated with
mood, among other things. Of these, about 70% get their prescriptions not from
psychiatrists trained in diagnosing and treating depression, but from
primary care physicians who often have neither the time nor the expertise to
fully evaluate their patients' mental health and advise them about different
therapies. Many primary care doctors aren't happy with this state of affairs,
but they feel pressured by health insurers not to refer patients to
The "if depressed, then Prozac" model puts millions of people
needlessly at risk of serious side effects. The most dangerous of these is an
"overstimulation reaction" that has been linked to compulsive thoughts
of suicide and violence. This risk of suicidal thoughts, which occurs in an
estimated 1% to 3% of patients, so alarmed the German equivalent of the U.S.
Food and Drug Administration that a warning appears in Eli Lilly and Co.'s
official information on Prozac in Germany.