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    Prozac: Pro and Con


    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.

    Suicidal thoughts and loss of motor control are not the only side effects of these antidepressants. Others include:

    • Severe withdrawal. It can take patients months to wean themselves off an antidepressant like Paxil without suffering symptoms such as dizziness, anxiety, and difficulty balancing.
    • Significant weight gain, often after initial weight loss.
    • A loss of effectiveness. Prozac, for example, wears off in about a third of patients within a year.
    • Sexual dysfunction, reported in as many as 30% to 60% of patients.

    These important concerns are downplayed by Prozac's manufacturer, Eli Lilly and Co. Moreover, the published risks are based on short-term studies. No one really understands how normal functioning of the brain may be impaired by Prozac-type antidepressants in the long run. Indeed, one worrisome study, published in the March 2000 issue of Brain Research, indicates that Prozac and Zoloft may be toxic to the very cells they target in the brain.

    Does this mean that no one should take these antidepressants? Emphatically not. I still prescribe Prozac and related medications for patients in my practice. I've seen firsthand the benefits they offer. But any drug that also has the potential for serious harm should be prescribed only by experts, and then only with restraint and careful monitoring.

    Patients should have moderate to severe depression symptoms that affect them to the point that they risk real damage -- the loss of a job or a relationship, or the abandonment of an important goal -- before they consider starting antidepressant medication. Even then, these drugs should be used in combination with other types of treatment, like psychotherapy, couples therapy, or 12-step programs in order to ultimately reduce long-term dependence on the drug.

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