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Prozac: Pro and Con

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No matter how benevolent and time-tested a medication, it will have side effects. If you consider those side effects out of context, without proper background, you might well be convinced that the drug is going to harm you, not help you. You might therefore give up the allergy medication that lets you go outside in the summer, the beta-blocker that helps control your heart failure, or the drugs that help stabilize your diabetes -- all based on "side effect panic."

Sound farfetched? Not really. In the wake of overhyped publicity about the side effects of antidepressants, spawned by Joseph Glenmullen's new book Prozac Backlash, I fear such panic will strike thousands of people whose daily lives are immeasurably better thanks to the prescription of antidepressants that are thought to regulate brain levels of the chemical serotonin in our bodies. These drugs, commonly known by brand names such as Prozac, Zoloft, and Paxil, have been carefully studied and are closely regulated. But you wouldn't know it to read the book by Harvard psychiatrist Glenmullen, MD, who paints a distorted picture of a psychiatric Wild West in which anything goes when prescribing these antidepressants.

My colleague at Yale, Harvey Ruben, MD, tells the story of a young man who came to him and said, "I've got to stop my Prozac." Why, he was asked, when he felt so much better since he'd been on it? "My fiancé says she won't marry me if I don't go off Prozac. She's afraid I'll kill her." The woman's fears weren't based on his behavior, but on stories she'd picked up in the media about extreme (and rare) side effects such as neurological problems, loss of sexual function, and psychosis. Based on such reports, the young man had to choose: his fiancé, or his mental health.

This story illustrates the dangers of a book like Prozac Backlash. It takes individual instances of known but rare side effects -- tremors and weight gain, as well as psychosis and sexual dysfunction -- and blows them out of proportion. Yes, side effects should concern both patient and physician, but they must be placed in proper context. Instead, Glenmullen exaggerates the risk. Indeed, some of the researchers whose work Glenmullen cites in the book, such as University of Massachusetts psychiatry professor Anthony Rothschild, MD, have warned that the book misrepresents their work.

Prozac Backlash and the antidepressant "chorus of doom" that accompanies it may unnecessarily frighten patients for whom antidepressants have been a godsend. Worse, they may choose to give up their medications -- risking far more serious personal, emotional, and medical problems than are posed by the comparatively small possibility of side effects.

Part of the problem is that the antidepressant critics see a symptom occur after a patient has taken Prozac and label it a side effect. Yet often we can't know if the symptom was actually caused by the drug. Consider suicide: Studies have shown that 15% of people with unsuccessfully treated clinical depression will commit suicide in their lifetime -- Prozac or no Prozac. So it's no surprise that Glenmullen found a handful of people who have considered or attempted suicide while on Prozac. It simply shows that we're dealing with a group of people who are very ill and who may attempt suicide regardless of what treatment they are given.

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