Prozac: Pro and Con
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 fiancÃ© 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.