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Prozac: Pro and Con

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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.

If your doctor suggests an antidepressant, ask for a referral to a psychologist or a psychiatrist for a second opinion. And should you start taking the drug, don't just blindly renew your prescription over the telephone. Sit down with your physician every six months or so to reassess your situation. Ask questions: Do you still need it? Can you lower your dosage?

As Maura learned the hard way, these antidepressants are not right for everyone. Don't accept the risks they may pose lightly.

Joseph Glenmullen, MD, a clinical instructor in psychiatry at Harvard Medical School, is on the staff of Harvard University Health Services and has a private practice in Harvard Square. He is the author of Prozac Backlash: Overcoming the Dangers of Prozac, Zoloft, Paxil, and Other Antidepressants With Safe, Effective Alternatives.

 

 Dangerous 'Backlash'

By Frederic Quitkin, MD

June 2, 2000 -- In the wrong hands, the scariest volume of horror stories in the world can be the Physician's Desk Reference -- the guide to drugs and drug interactions found in every doctor's office. I could take any commonly prescribed drug listed there, run through the list of possible side effects, and frighten any patient away from taking it.

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