Paxil, Prozac are generally safe — (Milwaukee Journal Sentinel)

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Milwaukee Journal Sentinel (WI)

August 9, 2004

Author: JULIE MITCHELL

Q. What is with the over-prescription of anti-depressants? Is everyone in the United States depressed or just the ones with good drug coverage?
Recently, I was talking with my co-workers and friends about other friends and family members on Prozac, Paxil and others. Many of us told stories about bizarre behaviors, a seeming “loss of conscience,” sexual acting-out . . . just general nuttiness.

Is it possible to abuse these drugs? Does anyone really know how these drugs work? Don’t we all get the blues from time to time and do we really need a pill to “feel better?

I know these drugs have been a literal lifesaver for some, but for others, these drugs just seem to wreck havoc on those around them.

A. The newer class of anti-depressants, called SSRIs, includes a number of medications including the ones you mentioned. They work by modifying the pathway of one of the brain’s neurotransmitters: serotonin. I would agree with your suggestion that we don’t “really” know how they work any more than we know how the brain composes thoughts or feelings.

These drugs are generally safe, with the latest warning to watch for worsening depression or suicidal thoughts on first starting the medication. And some experts do not think this warning is necessary: They propose that suicidality is a risk in people who first start SSRIs simply because people are usually started on SSRIs when they have reached a low point in their depression and have sought a doctor’s consultation. The established adverse effects in SSRIs include insomnia, agitation, sleepiness, nausea and headache, but not bizarre behavior. 

These medications do improve depressed mood in many people, and I have known them to be extremely useful. Depression is difficult to “measure”; that is, the diagnosis of depression is made by a health care provider putting together a constellation of symptoms, the social situation and the description of day-to-day function. Because of this and because the impact of depression is so individual, statistics are hard to give. That said, about 50% to 60% of people respond to their first anti-depressant after about two weeks of use. About 90% of people have better moods given more time on a particular medication or after a change in anti-depressant medication.

I wonder if the bizarre behaviors you notice are more related to a depressed person trying to cope rather than a direct effect of the medication. If you are concerned about someone close to you, you may suggest they seek psychotherapy or a specialist’s consultation. Depression can be treated without drugs.

 

Julie Mitchell is an assistant professor of medicine at the Medical College of Wisconsin. Send questions to her at: Medical College of Wisconsin Physicians & Clinics, 9200 W. Wisconsin Ave., Milwaukee WI 53226 or via e-mail at drjulie@mcw.edu. Copyright Medical College of Wisconsin.

Record Number:  2004080906210809