Prozac makes some lives better, others unbearable — (Austin American-Statesman)

SSRI Ed note: Psychiatrist prescribes Prozac to woman, she becomes hyper, can't sleep, he ups the dose, she attempts suicide.

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Austin American-Statesman

February 7, 1994


Melva Jean Cain says Prozac saved her life.  “It’s like a whole new world,” said Cain, who credits the increasingly popular psychoactive drug with controlling her chronic depression for more than four years now.

Eileen King, however, blames Prozac for her suicide attempt last August and the disabling brain damage the attempt caused.

“The rest of my life has been ruined,” King said.

Cain, an Austin native, and King, a five-year Austin resident, are the visible tip of what experts say is more than 6 million Americans (and counting) who have used the drug many call a miracle and some a curse.

Experts say satisfied users – who say the prescription green-and-white capsules that cost almost $2 each make them cheerful and self-assured – far outnumber the critics.

Approved for sale by the U.S. Food and Drug Administration in 1987, Prozac boasts worldwide sales of nearly $1.2 billion a year. Psychiatrists are not surprised.

“When properly prescribed by a qualified physician, it has an excellent benefit-to-risk ratio,” said Dr. William Reid, medical director of the Texas Department of Mental Health and Mental Retardation.

Reid said doctors with the state agency routinely use Prozac and its newer, anti-depressant cousins, Zoloft and Paxil, to treat moderate to severe depression. The ailment, characterized in its extreme form by a lack of the will to live, is estimated to afflict more than 24 million Americans.

Lawrence and Eileen King, however, feel very differently about the drug.

“She was depressed to some extent, but, until Prozac, she never threatened her life or anything,” said Lawrence King, a psychologist with the Texas Department of Human Services.

The Austin psychiatrist he identified as the physician who prescribed Prozac for his wife declined to comment. The couple is considering a lawsuit.

“I really believe it should be off the market,” Eileen King said.

Dr. Stuart Yudofsky, chairman of the department of psychiatry at Baylor College of Medicine in Houston, disagreed. He said Prozac and its cousins are safe and highly important in the treatment of mental illnesses.

“The only danger I see,” Yudofsky said, “is that the complex, multifaceted illness called depression will be oversimplified. It rarely can be handled with medication alone. It’s the quality of treatment with these anti-depressants that I worry about.”

He was seconded by Dr. Robert Zapalac, an Austin psychiatrist who treats Cain and is a former president of the Texas Society of Psychiatric Physicians.

“These drugs are very useful for treating panic disorder, obsessive-compulsive disorder and moderate to severe depression,” Zapalac said. “But they require dose adjustment. And most studies show that psychotherapy and medications are better than either alone.”

Cain, for instance, still combines talk therapy with Prozac.

“The drug took seven months to really kick in and be effective,” she said. “Others respond much more quickly. When it happened, it was as though I woke up one morning and saw things I’d never seen before. Things made sense that never had before.”

Cain, who now works as a consultant to MHMR, said she agreed to talk about her use of the drug to help combat the stigma faced by people with mental illnesses.

“It’ll take a few of us coming forward before we can change it,” she said.

Experts say Prozac and its cousins work by increasing the brain’s production of the chemical serotonin, a neurotransmitter. Lack of serotonin is believed to be inherited and has been associated with depression and other mental problems.

But the drugs are so popular – even with people who have no mental illness – that they are becoming part of a growing legal drug subculture. Some say they can change personality. Many psychiatrists consider that to be hype.

“I don’t think the unique emotional patterns that characterize individuals can be changed,” Yudofsky said. “All Prozac does is enable the personality to unlock itself.”

Increasingly, however, the drugs are prescribed by doctors as diverse as family practitioners and obstetrician-gynecologists – physicians, that is, with little or no psychiatric training.

“That is very common in Austin,” Zapalac said. “I don’t see it being prescribed as a cure-all. But I worry that these physicians don’t realize all the problems involved.”

As the chorus of satisfaction grows, groups like the Church of Scientology and the Texas Mental Health Consumers persist in raising what Reid, Yudofsky and Zapalac call discredited criticism that Prozac causes aggressive behavior and suicide attempts. The groups rarely mention Zoloft and Paxil, although they work the same way Prozac does.

“We don’t include them because we haven’t heard bad things about them,” said Jerry Boswell with the Church of Scientology in Austin. “We’ve had thousands of complaints on Prozac.”

Boswell and the mental health consumers’ group are petitioning the Texas Department of Health to put labels on all psychoactive drugs sold in Texas warning that they may cause suicidal or aggressive behavior.

Ralph Nader’s Public Citizen Health Research Group, a longtime critic of Prozac, raised the labeling idea with the FDA in 1989. The federal agency decided the evidence did not warrant it.

The Kings, however, want prospective users of the drugs to consider their tragedy.

Eileen King’s psychiatrist “put her on Prozac for about six to eight weeks, and I noticed she was extremely aggressive and hyper,” Lawrence King said. “The psychiatrist should have seen that she was not normal at all. She couldn’t sleep. She’d sit up all night working. He upped the dosage, and three days later she attempted suicide.

The attempt, an overdose of other prescription drugs, briefly stopped Eileen King’s heart, depriving her brain of oxygen long enough to damage it.

“She can hardly go to the mailbox and find her way back,” Lawrence King said.

Yudofsky and other experts said hyperactivity is a common early side-effect of Prozac and its cousins until their optimum dosage is established. They say depression can lead to suicide with or without a drug.

Melva Jean Cain, in her apartment, says the drug Prozac helps her control depression. `It’s like a whole new world,’ said the Austin native.

Record Number:  AAS277314