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.
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 (Norton 160). 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 defects. 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 (Cooper 727). 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 (Cooper 741). 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. Works Cited: 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): 158-163. Silverman, Harold M. The Pill Book. London: New York, 1992. Wilkerson, George. "The Boom in Depression." The Economist (1992): 73-75. Zimmerman, Peter. Physicians' Desk Reference. London: Thames, 1988.