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Pushing Prozac

What are the risks?

continued...

What about the studies that seem to indicate that placebos work just as well as antidepressants? Quitkin believes that some of these results may be attributable to flaws in the way the studies were designed and conducted. If a study isn't long enough, or uses an inappropriate dose, it may show a drug is less effective than it really is.

Some experts even call Glenmullen's book dangerous because it may discourage depressed people from seeking treatment. "The truth about depression is just the opposite of what the book claims," says Mike Faenza, president of the National Mental Health Association, which receives some funding from Eli Lilly and Co. Depression isn't overdiagnosed, it's underdiagnosed and undertreated, he says, and reports of antidepressants' risks are greatly exaggerated.

Years will likely pass before psychiatrists can accurately answer the question: Are Prozac and similar drugs worth it? In the meantime, even vehement professional rivals agree on some basic advice for patients like Carla. Antidepressants are useful to a great number of people, say both Prozac critic Glenmullen and supporter Ruben. The key for both physician and patient is to be cautious and conservative with these or any drugs.

"Don't start people who don't need the drug," Ruben says. "Start at the lowest dosage and monitor usage carefully. In my office, nobody ever gets an automatic refill. If you have to call and check in, we can monitor your usage. Doctors giving nine months of refills -- that's just negligence, and that's why we try to educate people."

Gina Shaw, a Washington-based medical writer, reports regularly for WebMD.

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