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Prozac's Can and Can't-do Powers

The drug of the 1990s doesn't alter personality, it relieves depression

So many claims have been made for Prozac's powers that its reputation as a wonder drug is hardly surprising. Dr. Randolph Catlin, Chief of Mental Health at Harvard University Mental Health Services, puts some of those claims into perspective here.

What does Prozac do?

In medical terms, it increases the level of a neurotransmitter called serotonin at the interspace between neurons at the midbrain - in the center of the brain underneath the cortex. What you see clinically is an improvement in a depressed mood. It increases one's sense of well-being, counteracting tendencies to depression.

When should a doctor prescribe Prozac?

It should be prescribed when there are indications that one is significantly depressed.

What are the advantages of Prozac over other antidepressants?

Prozac has two advantages over the many other kinds of antidepressants. It seems to have fewer side effects, and it is more of a true antidepressant. Many find that others just put a floor on depression - make it more tolerable - whereas Prozac seems to relieve the depression. That is also true for the other serotonin enhancers, which slow down the reabsorption of serotonin.

Is Prozac the wonder drug it has been described as being?

Prozac is not a wonder drug. People on Prozac do not have unusual or sensational results, but they do have good antidepressant effects. It's a very useful antidepressant.

The drug has been said to alleviate several other conditions, from bulemia to attention deficit disorder. Are those reports accurate?

Prozac has been approved by the FDA for treatment of bulemia and for obsessive compulsive disorders. It is occasionally used for panic disorders and more infrequently for attention deficit hyperactivity disorder. It has also recently been identified as a useful treatment for PMS.

Does Prozac alter the personality?

No. There is no way to create something that wasn't there. Doctors do find that a great number of people who are chronically depressed, after taking the drug, say they suddenly feel as if they were a different person. But it does not change their underlying personality.

Is it overprescribed?

It may be overprescribed. It is used widely by general practitioners. A doctor may conclude that his patient's chronic backache is related to depression and prescribe Prozac, especially since there is no risk involved. A doctor may prescribe Prozac for anything associated with depressed mood, even without a diagnostic work-up. It is important for anyone to get a thorough work-up before being prescribed Prozac, or any antidepressant.

What are the drug's side effects?

It can cause increased agitation, similar to caffeine jitters. Some complain of headaches or nausea. And there are reports of decreased sexual function, delayed or, eventually, complete inhibition of orgasm in women; and, in men, prolonged ejaculation or decreased or no ability to have a penile erection. In addition, there are some people, possibly quite a few, who complain that when on the drug they don't care very much about things that used to matter quite a bit. They sometimes get detached.

What risks are associated with Prozac?

The only real risk is for someone with a fairly serious liver disease. Prozac is metabolized in the liver. There is also a very small risk for someone with diabetes or a seizure disorder.

What about the claims that Prozac causes aggressive behavior or even suicides?

The people who become more aggressive on Prozac are probably those who have been suppressing aggressive tendencies. And there have been extremely few cases of suicide.

How long should one stay on Prozac?

One should stay on Prozac at least 6 months, and possibly up to 10 to 12 months. If, at that point, everything is stable in their lives, they can taper off and see how they do. Some people, however, may need to be off and on the drug for quite a while. It is not yet known if being on the drug for a longer period of time causes damage.


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