Prozac: It's not just for depression anymore.
The year 1993 proved a big one for Eli Lilly & Co., makers of
Prozac. Listening to Prozac, a testimonial to the drug's healing powers,
made the best-seller list, while Peter Kramer, its author, touted his
tiny benefactor on various talk shows. Again and again the pill popped up
in endless New Yorker cartoons, computer-network discussions, even David
Letterman jokes. In February of that year, the pill itself graced a cover
of Newsweek.
Slowly, stealthily, Prozac is slithering into more and more of our
lives and finding a warm place to settle.
Even the most casually aware citizen can feel the shift in thinking
brought about by the drug's ability to "transform" its users: We speak of
personality change, we argue over the drug's benefits over psychotherapy
(all those expensive hours of parent-bashing as compared to a monthly
dash to the pharmacy); and we let ourselves imagine a world in which our
pain is nullified, erased as easily and fully as dirty words on a school
blackboard.
Most of all, we envision a race of people both frighteningly bland
and joyously healed as the ultimate doubble-edged sword. While Prozac may
indeed be our gift horse of the decade, at least we're staring it
straight in the jagged molars.
Of all the fears and concerns, the one barely spoken of but no less
valid apparently has more to do with the good than the bad: It seems the
drug is more effective, and works to relieve more symptoms, than
previously imagined.
Without a doubt, Prozac is exiting the realm of clinical depression
and entering the murkier world of subclinical, subsyndromal, sub-"sick"
disorders, Clinicians in particular are worried that the of
"subsyndromal" disorders (psychological complaints that fail to meet the
criteria for a specific illness) is expanding to include more of what
were once thought of as ordinary life stresses. (The unofficial term for
this is "bracket creep.")
And as this illness invitation list grows, so, of course, do the
numbers of patients who now fall into this category-- people somewhere
short of being honest-to-God sick but who are nevertheless in some sort
of pain.
Robert Trestman, M.D., director of the outpatient program at Bronx
VA Medical Center, sums up the dilemma: "There are many situations where
people do not meet the minimum criteria for a disorder. Where a specific
diagnosis may five criteria, for instance, some people will have only
two, perhaps even one. And yet they're suffering."
And receiving psychiatric medication when once they were shipped
off to a therapist's couch. Trestman neatly breaks down the dividing
lines between the sick and the uncomfortable:
* Traditional patients, who say, "Doc, can you fix me? I'm
hurting."
* Nontraditional patients, who say, "I'm not broken, but make me
better. I want to be more assertive, I want to feel better, I want to
accomplish more."
In the past, both groups would be recommended for therapy. Now,
more and more are being tried on Prozac. Because of its fewer side
effects and lower toxicity, the risk-to-benefit ratio is a lot
lower.
"It's lower," agrees Trestman, "but it's not zero. There are side
effects, risks that raise concern in the medical community."
GOOD NEWS OR BAD!
Historically, the use of drugs as fixers of the world's private
ills has run into serious, if unanticipated, snags. At the turn of the
century, the medical community thought that cocaine was a completely
appropriate, nonaddictive drug, and widely prescribed it. In the 1950s
and '60s, first barbiturates and then amphetamines were doled out for
various psychological maladies. We now know that each of these drugs came
with significant risks. So what yet-to-be-imparted knowledge may cause
science, once again, to admit sheepishly that the exuberance over Prozac
was somewhat premature, if not wholly overblown?
While much remains to be learned about Prozac, so far the bad news
may be that there's no bad news. If after all, it does turn out to have
no serious drawbacks, what are the implications of a drug that is a
shortcut to healing?
It is a concern that potentially affects all psychologists, who may
find themselves short of angst-laden clients in the coming years; that
places dubious power in the hands of primary care physicians, who may
prescribe the drug without a fully articulated understanding of their
patients' distress; and that strikes a chord of defensive fervor in the
hearts and minds of everyone raised with the Judeo-Christian ethic that
nothing in life can be worth-while, or effective, unless you work for
it.
There's more to the story. Questions abound regarding the drug and
its chemical cousins, Zoloft and Paxil: What other types of disorders,
aside from clinical depression, are they being prescribed for? Do the
medications work? What other options exist? What are the potential risks
to individuals and to society?
I'M DYSTHYMIC, YOU'RE DYSTHYMIC
Of all the distresses, ailments, and infirmities patients complain
of nowadays, perhaps none is so broad or so muddy in definition as
"dysthymia"--a chronic discontent involving depression (but not clinical
depression) or irritability. Its symptoms--not eating or eating too much,
not sleeping or oversleeping, poor concentration or difficulty making
decisions--reveals the unexclusivity of its rank and file. In terms of
requirements for diagnosis, dysthymia may be the only club that would
have Groucho Marx for a member.
Tags:
benefactor,
best seller list,
cartoons computer,
computer network,
depression,
dysthymia,
edged sword,
gift horse,
healing powers,
listening to prozac,
medication,
molars,
network discussions,
new yorker cartoons,
personality change,
prozac,
psychological complaints,
therapy
