SSRI Ed note: Depressed British doctor takes Prozac out of curiosity, it makes him feel agitated and violent. He stops when he realizes he could harm someone.

Original article no longer available

The Sunday Times

16 October 1994

(c) 1994 Times Newspapers Ltd Not Available for Re-dissemination.

Hailed as a wonder drug with few side effects, could a different, darker side of Prozac be starting to emerge, asks Christa D’Souza.

Last year Geoffrey Williams, 56, a successful and much respected obstetrician living in the Midlands with his wife and two children, fell into an unexplained depression. He could not seem to kick it. “I woke up in the morning and could hardly drag myself out of bed,” he remembers. “It was an effort doing minuscule things such as paying the bills and posting letters. Work was my only salvation I knew I had to go into the hospital, people depended on me. I didn’t want to kill myself I’m too much of a coward for that but I felt miserable and wanted to do something about it.”

Williams (not his real name) thought he knew all about Prozac. Hailed first in America as a modern wonder drug, a feel-good cure for the angst of modern life, the benefits of the anti-depressant were now being extolled by Williams’s own colleagues. He decided to try it, impressed by reports that there were few side effects. “I got hold of the pills myself, being in the business. Nobody knew I was taking them, besides me. I had no idea I was going to react to them the way I did.

“After about a week I became almost unbearably agitated. I couldn’t sleep and couldn’t eat. I found myself snapping at the children for no reason at all. After six weeks, I had to stop taking them because I was frightened of what was happening to me. I was near to throwing someone up against a wall and throttling them. Thank goodness a waiter didn’t cross me while I was taking the drug.”

Williams must have read with interest the latest story concerning Prozac, reported in The Sunday Times last weekend. It involved an American named Joseph Wesbecker, who gunned down eight people in 1989 in the printing plant where he had worked for 18 years, then shot himself. It so happened that he had been taking Prozac. Now, five years later, the victims’ families are suing the makers of Prozac for $100m damages, alleging that the manufacturers knew that the drug made some takers violent. (The company, Eli Lilly, is vigorously defending the claims and counters that Wesbecker was seriously ill beforehand.)

They are not the only ones. More than 200 former Prozac-users in America have attempted to win damages from Eli Lilly, claiming that Prozac, dubbed “Bottled Sunshine”, has triggered suicide, murder or even self-mutilation, though none of these lawsuits has yet succeeded. In this country, there are 50 civil cases against Prozac drawn up, though, according to Eli Lilly, no actual writs have yet been issued.

One of those 50 involves Duncan Murchison, 43, a former water board employee from Inverness, who, while taking Prozac, was sent to prison for threatening to shoot his girlfriend and her young son. Murchison hopes his case, if successful, will be a landmark: “Once one case has been into court and won, it’s not going to be so difficult for the others.”

Can it be, then, that there is a yet-to-be proved dark side to the drug compared with Soma, the universal palliative of Aldous Huxley’s futuristic novel, Brave New World?

Released on to the market just seven years ago, Prozac is probably the best known and best selling anti-depressant of all. An estimated 15m people worldwide are taking it last year it made Eli Lilly $1.2billion though the drug is not yet approved of in Norway or Sweden. An estimated 500,000 of those are British, prescribed it through GPs diagnosing depression.

“It’s like wildfire,” is the way one woman, who has been taking it for two years, puts it. “When I first started, nobody had heard of it. Now I know 10 people who swear by it.”

In a sense, how could there not have been a backlash? Prozac has been the cover girl of the 1990s, the subject of countless, almost messianic testimonials in the press from people such as Donald Trump, Jim Bakker, Gary Hart and Roseanne Arnold. It has even been prescribed to problem pets by American vets. Credited with making millions happier, thinner, nicer, less obsessive and more successful, it is inevitable, somehow, that a few of us might be wondering whether Prozac might not just be too good to be true.

Eli Lilly, naturally, has taken enormous measures to prove that it isn’t. Others, in the medical profession, also counsel against alarmism in the wake of Wesbecker case: “The idea that Prozac may cause suicidal ideation (ie fixation) is contrary to existing scientific data, which is derived from carefully controlled trials, not anecdotal case reports,” says Ian Hindmarch, professor of psychopharmacology at the Robens Institute of Surrey University, and an expert in anti-depressants. “As soon as you get a drug with such a high profile as Prozac just like the drug Halcyon the plaintiffs’ lawyers see there is money to be taken. It’s as crude as that. Lawyers try to establish causality when it’s mere correlation. Prozac is a wonderful substance for people who need it.

“Science shows quite clearly there is no increased risk of violence or suicide with Prozac. Suicidal ideation is one of the reasons that patients are given anti-depressants in the first place. In other words, the underlying illness is already there.”

According to Hindmarch, Prozac is much more difficult to obtain from the doctor in Britain than in America. “If you’ve been prescribed Prozac in the UK, it is because your doctor believes you suffer from a psychological disturbance called depression,” he insists. “That’s not just feeling down, that’s an actual disturbance of thought.” On the other hand, I have heard countless testimonies from people who have walked into their doctor’s office, complained of `feeling down’ and walked out half an hour later with a prescription.

However, Professor George Masterton, a psychiatrist at Edinburgh Royal Infirmary, adds: “I would not say Prozac directly causes suicidal thoughts. But I have seen patients in whom the thoughts did not seem to come from them. It does, at least, put a question mark over the drug.”

Causality or correlation? This is one story, recounted by Pam Armstrong, a former nurse who now runs the Liverpool-based Council for Involuntary Tranquilliser Addiction (Cita): “A girl of 22 was diagnosed by her doctor as suffering from panic attacks,” she says. “He put her on Prozac. After about two-and-a-half weeks, she started having fits with epileptic symptoms and was taken to the hospital. Her whole family were convinced it was epilepsy, but the neurologist who gave her a brain scan insisted it was stress.

“Whatever the case, if you look in any drug manual you will see that having fits is a possible side effect of Prozac.”

Here is another story. In February I interviewed Julia, aged 28 and a publisher’s assistant, who had suffered panic attacks. She told me: “If need be, I will take Prozac for the rest of my life.”

Eight months later, and her story is very different.

“I was so euphoric I went over the top. I got into the habit of drinking and taking drugs which I never did normally and it got to the point where I was out of control.” The scientific literature states clearly that Prozac is not addictive, though Julia’s account of giving the drug up three months ago hints at, at the least, some sort of psychological dependency.

“I decided I’d do it `cold turkey’, but for the first week or so, when I felt panicky at work, I’d pop two and feel a lot calmer three hours later,” she recalls. “I’ve stopped doing that, but every day I fantasise about going back on it. In my handbag I’ve got three packets of it, which I’ve been carrying around. Prozac gave me a false sense of security. After I lost that crutch that confidence was no longer there.

“As for now, I feel really lousy. I have sunk back into a terrible depression. I’ve put on 2 stone the temptation to go back is very strong. But I know there is more I can do to help myself than by popping a pill. It feels like I am kicking an addiction.”

Many doctors who have prescribed Prozac predict that it will take at least a fortnight to take effect. That assertion, too, may repay closer examination, not least because of reports of would-be “recreational” use.

According to one Londoner I interviewed: “My girlfriend was taking Prozac and I tried one to see what it was like. It gave me exactly the same feeling as Ecstasy a slight ringing in the ears and a detachment from the real world. I didn’t like it at all.”

Already the drug has been high-jacked by the club scene.

“It is definitely becoming commonplace in the clubs,” says one London nightlife regular. “Kids take Prozac and drop a tab of Ecstasy because they think it is going to enhance the effect. I’ve never seen anyone actually dealing Prozac in a club, but I’m sure it’s the next step it’s just a question of getting your hands on it.”

“If you look at it historically, many drugs billed as wonder drugs have ended up being disasters,” says Pam Armstrong. “The sad thing is that people coming off tranquillisers still feel a bit rough and they get shoved on Prozac. It’s such an across-the-board prescription. Prozac is very new. It should be very closely monitored, and no doctor is in a position to do that sort of monitoring. It is still being tested, that is what people don’t appreciate.”

“Did I always have a temper?” wonders Geoffrey Williams in retrospect. “I’ve always been a fairly aggressive person, but never violent, I’d always been able to keep my cool. On Prozac, I felt physically incapable of controlling my aggression.” Who knows, Williams now wonders, what would have happened had he not taken himself off the anti-depressant. Who, indeed?