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San Antonio Express-News
July 31, 1994
Anti-depressants not shown to evoke violence
I am an inmate in the state correction system serving 10 years for repeated driving under the influence of alcohol and vehicular manslaughter. My problems started when I was diagnosed as suffering from depression and prescribed an anti-depressant called Prozac . Before using that drug I was devoutly against drunk driving, but about three months after starting it I became very jumpy, restless, got three DUIs and then the vehicular manslaughter charge. Could Prozac have caused me to act differently? What problems occur with Prozac ? -M.J., Grovetown, Ga.
Prozac is an anti-depressant known to cause problems such as nervousness, tremor, seizures, nausea and headaches, but it has not been shown to be a direct cause of violent acts, including suicide. People taking Prozac or other anti-depressants may experience personality changes for a range of reasons: The stress of waiting for improvement may worsen their mental state or the anti-depressant may produce symptoms of a different, un-diagnosed mental illness. Finally, depressed people often abuse drugs and alcohol.
An estimated 20 million Americans experience depression at some time in their lives, although most are never diagnosed. Depression is a serious disorder and considered life-threatening. Nearly 80 percent of all depressed people contemplate suicide, and 20 to 40 percent of all of them attempt it.
Over the past 25 years anti-depressant drugs have been the dominant treatment for depression. Most anti-depressants are descendants of and improvements on one of the very first mood-controlling drugs called imipramine. The newer types of anti-depressants are called selective serotonin reuptake inhibitors, or SSRIs, which have the positive qualities of imipramine but try to remove or reduce some of its negative aspects, such as abnormal heart rhythms. SSRIs include serraline, paroxetine, fluvoxamine and fluoxetine, known by its brand name of Prozac .
Manufactured by Eli Lilly and Co., Prozac was first introduced in 1986 and is the most widely used anti-depressant. More than 10 million people have been prescribed it. Studies show it is as effective as other anti-depressants, but it has fewer side effects.
According to several studies, the side effects of Prozac can include nervousness, tremor, jitteriness, nausea, insomnia, headache, fatigue, mania or manic symptoms, dizziness and, rarely, seizures.
Over the past several years there have been numerous reports of violent acts and suicide by Prozac users. Although medical journals have numerous reports of such acts, medical studies have not found evidence that Prozac causes violence or suicide.
A recent study by Dr. Gary Tollefson, a researcher at Eli Lilly, of 3,065 depression patients taking Prozac supported other researchers’ studies in finding that there was no increased risk of suicide. The study was published in the June 1994 issue of the Journal of Clinical Psychopharmacology.
In Tollefson’s study, about 2 percent had suicidal ideas and 0.2 percent of the patients attempted suicide.
“Suicide is so common in a population suffering from depression that you can’t necessarily blame the drug. As an analogy, if a migraine sufferer is given medication and then has a headache, do you blame the medication? The situation is similar with depression,” said Susan Sonne, researcher in the department of psychiatry, Medical University of South Carolina, Charleston, S.C., in an interview.
However, people taking Prozac or other anti-depressants may experience personality changes for a range of reasons, experts say:
– Most depressed people do not seek help until their problem is serious and often desperate. When placed on anti-depressants, including Prozac , the side effects of the medicine start immediately but the therapeutic benefits may take four to 12 weeks. During the first few weeks a patient may become more distressed and panicked that the drug hasn’t made significant changes, and as a result may act even more irrationally.
– There may be too little or no therapeutic effect from the medication. The drug may reduce the symptoms by 50 percent, which is considered a therapeutic level, but the effects experienced by the patient may not be enough. Or the drug may have no therapeutic effect at all, which occurs in about 30 percent of patients. The drug dosage may also be too low and thus ineffective. Experts believe this can panic the patient and make their depression much worse.
These situations may also trigger new or increased alcohol consumption. “A depressed person who isn’t responding to medication may resort to self-medication with alcohol,” said Dr. Alexander Morton, professor of psychiatry and behavioral sciences at the Medical University of South Carolina, in an interview. Alcohol and drug abuse occurs in more than half of those with depression.
– The patient may be receiving treatment for depression, but actually has an underlying, undiagnosed bipolar disorder, such as manic-depressive disorder. Research shows that an anti-depressant can somehow trigger a switch from depression to a manic state. Symptoms typical of mania include euphoria, high energy level with poor judgment, risk-taking, delusions of grandeur and a need for excitement.
“Since a patient suffering from depression may be very compromised and, by virtue of their condition, incapable of helping themselves, it is important for family and friends to intervene when strange behavior is seen. For instance . . . .. after one uncharacteristic DUI I would intervene, find an alcohol or drug treatment program and try to receive a full evaluation of the situation,” Morton said.
The Medical Adviser is produced by the Palo Alto Medical Foundation using a data base that contains articles from more than 3,500 medical journals around the world. Send your questions to the Medical Adviser in care of the San Antonio Express-News, P.O. Box 2171, San Antonio, Texas 78297-2171.medicine