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Pushing Prozac

What are the risks?

continued...

Alarmed, she went back to her doctor. She next tried Prozac -- that had problems too -- and finally settled on 50 milligrams of Zoloft each day. Never once has she gone to a psychiatrist or psychologist during these five years. Such expense seemed unnecessary; after all, she is taking antidepressants. Lately, though, she wonders. She's starting to feel depressed again, and her once-a-day Zoloft doesn't seem to help much. "My biggest frustration is that I wish I could enjoy sex more," Carla says.

Today, some psychiatrists question whether patients like Carla really need to take antidepressants for years, or whether a dummy pill or therapy alone might work just as well. Several recent studies indicate that many of the beneficial effects attributed to antidepressants can be explained by the "placebo effect" -- the improvement many people experience when they believe they're taking medicine.

In the April issue of the journal Archives of General Psychiatry, researchers analyzed studies of seven new antidepressants, using the Food and Drug Administration's vast database. Their conclusion? The rates of suicide and suicide attempts were just as high among patients treated with antidepressants as for those who took placebos.

"When you look at the reviews, it appears that about six out of 10 patients do achieve some level of benefit. But the issue is, how many of those six are achieving a benefit that they wouldn't achieve with a placebo or some other approach?" asks Roger Greenberg, PhD, a psychologist at SUNY Upstate Medical University at Syracuse and author of From Placebo to Panacea. "I'd say that out of the six, only about two are receiving a unique benefit from antidepressants, and even that is questionable."

Should people who feel better on Prozac shred their prescriptions? Not just yet. This debate is far from settled.

Some leading psychiatrists and mental health advocates are outraged at the views of Glenmullen and other critics. "Patients say to me, 'I feel normal for the first time in my life,' " says Harvey Ruben, MD, a clinical professor of psychiatry at the Yale School of Medicine.

Ruben calls much of Glenmullen's book "pure speculation." Yes, the antidepressants cause side effects in some patients -- every drug does. "For any drug, if you look in the Physician's Desk Reference, there are probably 150 side effects, many of them so severe that you'd probably never take the drug if you read them," he says. "Glenmullen has taken legitimate side effects, which are very rare, and some terrible case histories, and written a book that makes the uninitiated reader believe that these side effects happen to everybody."

Several psychiatrists also dispute the studies that question the clinical effectiveness of antidepressants. "If you look at all of the studies in the world literature, there are no studies in which a placebo is better than an antidepressant," says Columbia psychiatrist Frederic Quitkin, MD. "In 60% to 70% of the studies, the antidepressant performs better than a placebo. It's simply impossible for that to happen by accident."

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