The psychotropic drugs have so revolutionized psychiatric
treatment that the number of patients in public mental
hospitals in the USA alone has decreased by approximately
200,000 in the last 15 years. The influence of the new
psychotropic drugs has been even greater in private
practice and the office physician can now effectively treat
many psychiatric disorders. The effectiveness of
pharmacotherapy has also brought about a change in the
pattern of delivery of services. The majority of patients
no longer need admission to in-patient psychiatric
facilities and those who have been in psychiatric hospitals
can often be discharged to the care of the family doctor.
As a result, the psychiatrist can be used more selectively
as a consultant for diagnosis and treatment of difficult
As with many physical diseases, the realistic objective of
psychiatric treatment is often not a complete remission but
rather the restoration of an adequate level of basic
functions necessary for a satisfying and productive
existence. When this therapeutic goal is attained, the
medication must not be discontinues abruptly. The idea that
the patient can become well, or stay well without
medication is false. In psychiatric illnesses, as in many
physical diseases, maintenance therapy may be both
legitimate and necessary.
The mechanism of action of psychotropic drugs, like the
causes of psychiatric diseases themselves, is large
unknown. The antidepressants cause elevations in CNS levels
of biogenic amines. The tranquilizing antipsychotic drugs
tend to reduce amino levels. It is thus tempting to assume
that elevation and depression of mood are directly related
to similar changes in CNS concentrations of biogenic
amines. However, this thesis remains unsubstantiated.
Individual responses to psychotropic drugs vary
considerably, both in degree of effect and in the period of
time required to attain the peak effect. Similarly, optimal
dosage schedules vary greatly for individual patients. Thus
rational selection of therapy is often difficult and it is
not surprising that opinions differ widely about the place
of drugs in psychiatric therapy and their optimal use in
specific clinical situations.
The drug Prozac is one of several drugs that is looked upon
as the psychopharalogical miracle of our time. It is
designed for a specific group of patients, but sometimes is
prescribed for anyone who wants it without being told of
its side effects. The only one reaping the benefits is the
manufacturer, Eli Lilly, while the public suffers. Prozac
is an antidepressant for oral administration (Zimmerman
943). It is made up of fluoxetine hydrochloride which is
chemically unrelated to the older antidepressant medicines.
It works by allowing the passages of a neurohormone,
serotonin, into nervous system cells (Silverman 357). In
turn, this increases the availability of serotonin at the
critically important brain receptor cites, thought to
result in normal nervous system transmission (Fieve 46).
Officially, Prozac has been approved for treating only two
serious mental diseases; clinical depression and
obsessive-compulsive disorders (Cooper 736). It has been
shown that Prozac used in treatment for depression and
obsessive-compulsive disorders works for three out of four
who try it for treatment (Wilkerson 74).
Since its introduction, over eleven million patients
worldwide and six million in the United States have taken
Prozac. These people cover the gamut from children to the
adolescent to the elderly (Fieve 11). Name any randomly
chosen group of successful people in society, business,
politics, or the arts, and it is likely that twenty percent
to thirty percent of them are either taking Prozac or have
been given Prozac at some point over the last several years
Prozac today has become so popular that it is being
prescribed for everything form severe depression to
premenstrual prescriptions. Many users of Prozac never even
consult with a mental health specialist (Cooper 732).
Prozac was designed to be used in conjunction with talk
therapy, instead, it is being dispensed by doctors whose
patients ask for it by its brand name.
These people are not clinically depressed or have
obsessive-compulsive disorders for which the FDA had
approved its use (BeGley 37). Often, essentially healthy
people with dysthymic or those who were especially
sensitive to rejection were taking Prozac. For these
individuals, the drug amounted to what is called "Cosmetic
psychopharmocology," a treatment to make themselves better
rather than well (Cooper 739).
Prozac has many hidden side effects, some of which are just
now coming to the surface. Some of these include
nervousness, anxiety, sexual dysfunction's (particularly
delayed or absent orgasms), insomnia, and fatigue (Kirkland
6). Prozac is also believed to cause just the opposite
effect of what it was designed to accomplish. In some cases
it caused obsessive and violent suicidal thoughts and even
violent behavior (Carlson 24). The makers of Prozac, Eli
Lilly, attribute the violent or suicidal ideas and actions
of Prozac users to the underlying conditions of depression
(Cooper 734). The advocates state that Prozac has not
caused or aggravated the symptoms, it has merely helped the
patients (Bower 231).
Prozac does have fewer side effects than older drugs like
it, however, physiological side effects are just now coming
to the surface (Kirkland 7). In the Brandes's study,
published in July 1992 in the Journal Cancer Research,
rodents were deliberately given cancer. One group of
rodents was then injected with mouse-size equivalents of
human doses of Prozac. Rather than letting the animals live
out a normal life span of eighteen and twenty-four months;
the rodents were killed after only a few weeks. Their
tumors were two to three times heavier than the tumors in
the rodents not exposed to Prozac. Although Prozac has been
proven not to cause cancer, it has yet to prove that it
will not accelerate cancer in patients who already have
cancer (Brink 58).
Many young women of child bearing age are treated for
depression; no one is sure if it is safe for them to take
their needed medication during pregnancy. A new study in
the Journal of the American Medical Association proves a
mixed answer. Researchers followed women who became
pregnant while receiving therapy with Prozac. Women in both
groups, those who took Prozac and those who did not, bore
the small risk of having children with serious birth
The women on Prozac showed abnormal high rates of
miscarriages. More study is needed to determine if the
medication of the depression could be bringing pregnancies
to a premature end (Carlson 24).
Prozac has been hailed as the miracle drug of the nineties.
To the maker of Prozac, it is their bread and butter. In
1987 Eli Lilly launched Prozac. It only produced one
billion dollars a year in America, and two billion
worldwide (Wilkerson 175). In 1994, sales hit an estimated
fifty-eight billion. Antidepressant account for about three
percent of all prescription drug sales in the United States
With the high cost of health care, many physicians say they
are being pushed to favor drug therapy over psychotherapy
for the simple reason of cost. A really good psychiatrist
is probably going to charge $150 an hour. Prozac, on the
other hand, is just $15 a week. Prescribing drugs for
mental problems is cheaper than traditional talk therapy
Drug therapy does not solve the problem; it only hides it.
With this the drug company, such as Eli Lilly, get richer,
while people with mental disorders keep their problems.
Prozac might by the miracle drug it is claimed to be, but
much consideration is needed before one prescribes it.
Begley, Sharon. "One Pill Makes You Larger and One Poll
Makes You Small." Newsweek (1994): 37-41.
Bower, B. "Efficacy of Antidepression Drugs Challenged."
Science News (1992): 231-232.
Brink, Susan. "a Different Kind of Cancer Risk." U.S. News
and World Report (1995): 58-63.
Carlson, Thomas H. "Depression Danger." Time (1994): 24.
Cooper, Mary h. "Prozac Controversy." Congressional
Quarterly (1994): 721-742.
Fieve, Ronald R. "Prozac". New York: New York, 1994.
Kirkland, Laura. "Antidepressant Drugs: Same Effectiveness,
Different Side Effects." Health Facts (1995): 6-8.
Norton, Doug. "Most Promising Industries." Fortune (1994):
Silverman, Harold M. The Pill Book. London: New York, 1992.
Wilkerson, George. "The Boom in Depression." The Economist
Zimmerman, Peter. Physicians' Desk Reference. London: