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The Perils of Prozac
Part II

Note: If you or anyone you know are currently taking an SSRI and are doing well on it do not discontinue your medication based upon this article. Although the information presented here may be disturbing, it does not mean that you will become violent while taking SSRIs. In fact, if you discontinue a medication that is working well for you, you may risk withdrawal symptoms, depression or suicidal feelings. You should never discontinue any medication on your own. Always consult your physician first.

INTRODUCTION

In Part I we took a look at what some have speculated is a causal link between SSRIs and rising rates of violent crimes. Almost immediately after the article appeared, I began to receive reader feedback on this controversial topic. A heated discussion began on the tAPir message board as well. I invite you to read these emails as well as the tAPir discussion. I also hope you will head on over to our boards and share your own thoughts and feelings about this topic.

This week we look at one person's experience and what the experts say may have caused this type of reaction.

A PATIENT'S EXPERIENCE

Like many of you who wrote in, I have been hearing about the dark side of Prozac for several years now. When I first began my own treatment with Prozac four and half years ago I read everything I would get my hands on. I have a whole library of books like Talking Back to Prozac and Listening to Prozac. I pooh poohed the idea that Prozac could be dangerous. I felt that Peter Breggin's claims were grossly exaggerated and sensationalistic. After all, he just wanted to sell books, right? Also, I wanted desperately for Prozac to be the answer to all my problems. For the most part, it did work great. Sure, I had to take benzodiazepines to control the anxiety it caused me. Also, my moods were flattened. I had no extreme lows anymore, but I also didn't have even the normal ups and downs that make life interesting. Perhaps worst of all were the sexual side effects, which can put a strain on even the best of marriages. All in all, I still thought Prozac was worth these tradeoffs if it kept me from feeling so depressed I wanted to die.

At this point, you may be expecting that I will say that I had a bad reaction to Prozac. No, the worst of it was what I've just described. What I would like to tell you about is a story I recently heard from a friend; a story which prompted me to reexamine my own beliefs about Prozac's safety.

This is her story in her own words:

Dear Nancy,

Yes, I have had a bad experience with Prozac. I was in need of seeing my regular Psych. Unfortunately he was booked up and was not able to see me anytime soon. He suggested that I see my regular MD. The next day I made an app to see my regular MD and seen him the very same day. After explaining to him that I felt as if my meds were no longer of any benefit, he then prescribed Prozac. I had the prescription filled the very same day. The next day I started taking the med. I was prescribed to take one in the morning and one in the evening (I can't remember the mg's) but that morning I got up and took one of them. By afternoon I started to feel a bit funny, kind of out of it. As the day progressed I started feeling more and more depressed. By that evening I was suicidal. I just thought that I was going through a mood swing and that it would soon pass. By the time the second dosage was due I was totally suicidal. By totally I mean I had even had a plan as to how to kill myself. Passing it off as a mood swing I thought that the second dose of Prozac might pull me out of it, so I took the second dose. Three to four hours later I was nearly out of my mind. My thinking was totally distorted. In my mind I had no reason to live. Later that night after a short confrontation with a neighbor, I had made my mind up to kill her. At that point I really didn't care if I died in the electric chair (I am not the type of person to even confront a person in a mean way). But that night I was out of it. Thank God it was late at night because I went home and went straight to bed. By the next day the feelings of suicide and homicide had eased. Until I decided to take another dose of Prozac. That morning as scheduled I took my third dose. Again three to four hours later all feelings had progressed into a deeper state. Suicidal and homicidal feelings where both more intense. By late afternoon I was so suicidal and homicidal I was thinking of ways and times to kill my neighbor and then kill myself. After a realization from me of what I was actually thinking and even at that point plotting I come to the understanding that my suicidal and homicidal feelings seemed to be progressing with every dose of Prozac I was taking. So I decided to stay locked up in my bedroom and NOT leave the house at all until these feelings were completely gone. At that point I also decided NOT to take any more Prozac. Thankfully, within a couple of days all of these awful feelings were gone. Now I understand that Prozac has and is still helping many people but it is definitely not a wonder drug for all people. I hope that this has helped someone
.

EXPERT OPINION

What my friend described to me might well be written off by some as just a manifestation of a depression she was already being treated for. Some medical experts, however, say that this reaction to Prozac is not an isolated case. Dr. Robert Bourguignon, MD has the following to say about Prozac:

"It is my opinion that Prozac can induce psychotic episodes in a small percentage of patients (5-7%), especially those with borderline or manic personalities. In a small minority of these people, psychosis manifests itself by dangerous behaviors such as self-mutilation and suicidal/homicidal ideation and acts. So far, Lilly has refused to conduct (or publish the results of) double-blind studies specifically developed to find out more about these possible side effects. In my opinion, by refusing to do so, Lilly fails to meet normal standards in health care."

In a letter to the prominent medical journal, Lancet, he further details his concerns for his colleagues in the medical community. He cites aggressiveness, tremor, convulsion, and liver disorders as further side effects of Prozac usage that need to be given more attention by physicians. He further makes the allegation that Eli Lilly's reassurances to the medical community that Prozac is safe and effective have caused physicians to not monitor their patients as closely as they should.

Perhaps the most vocal critic of Prozac has been Dr. Peter Breggin, author of Talking Back to Prozac.

In his book Talking Back to Prozac Breggin makes some devastating claims about Eli Lilly. After researching clinical trials of the drug before it was marketed he concluded that these trials were inadequate because:

  • they were too short (four to six weeks);
  • they did not include children, the elderly or the suicidal;
  • many patients dropped out following adverse reactions;
  • patients were given sedatives to reduce Prozac's stimulating effect;
  • fewer than one in three trials showed Prozac to be effective; even these suggested that it was no more effective than previous antidepressants.

"The FDA supports the drug industry and its needs at the expense of the public and the consumer," writes Breggin. He adds that an early in-house FDA report, ignored by the organization's top decision-makers, described Prozac as a stimulant that could, in a few cases, over-stimulate the central nervous system and worsen depression.

Most recently Breggin has spoken about Luvox, another Selective Serotonin Reuptake Inhibitor (SSRI). Eric Harris, the "leader" in the Columbine High School tragedy, was taking this medication for depression. Although this drug, in the same class of drugs as Prozac, is approved for the treatment of obsessive compulsive disorder, doctors often give it for depression, since it is in the same SSRI class as Prozac and Zoloft.

Breggin's article states that:

"According to the manufacturer of Luvox, Solvay, 4% of children and youth taking Luvox developed mania during short-term controlled clinical trials. Mania is a psychosis which can produce bizarre, grandiose, highly elaborated destructive plans, including mass murder. Interestingly, in a recent controlled clinical trial, Prozac produced mania in the same age group at a rate of 6%). These are very high rates for drug-induced mania--much higher than those produced in adults. Yet the risk will be even higher during long-term clinical use where medical supervision, as in the case of Harris, is much more lax than in controlled clinical trials. These drugs also produce irritability, aggression or hostility, alienation, agitation, and loss of empathy." (Author's note: No information was given in the Breggin article about where the rates of mania in Prozac patients was obtained from.)

HOW PROZAC MIGHT PRODUCE VIOLENT BEHAVIOR

Prozac is a drug that is prescribed to treat depression, calm people down, and help them cope better with life. For most people it does just that. How could it have just the opposite effect on some people?

In a Web article entitled The Dangers of Prozac, Gary Null, Ph.D. and Martin Feldman, M.D. provide a discussion of the potential undesirable side effects of Prozac and how these may lead to suicidal and violent feelings. In summary these are:

Akathisia - This is a sense of anxiety, which makes a person feel compelled to move. It may manifest itself as pacing, foot shuffling or other similar behaviors. Dr. Breggin has described it as "like chalk going down a chalkboard, only it's your spine." Prozac also can cause extreme agitation, and this condition often is associated with akathisia.

Akathisia has been related to a breakdown in the ability to control impulses. Several journal articles have reported an association between akathisia and suicidal or homicidal thoughts. References for these and all scientific journal articles referred to below can be found within Null and Feldman's article.

Psychosis - A person's nervousness may reach a psychotic level when the overstimulation of the nervous system is severe. People can become paranoid, extremely depressed, suicidal and dangerous to others around them. They may behave in bizarre ways. Prozac's ability to induce mania in patients has been documented in a number of medical journal. Dr. Breggin holds the position that a drug's therapeutic effects and its toxic effects are simply a matter of degree in the same continuum. In fact, says Dr. Breggin, "Many patients who swear by Prozac are probably experiencing imperceptible or barely perceptible degrees of mania.".

Suicide - Beyond the link between akathisia and acts of violence, some users of Prozac have said that the drug caused them to develop suicidal thoughts and obsessions. In some cases, the use of Prozac allegedly has prompted people to commit murder. This aspect of the drug has generated controversy and led to discussions in both medical publications and the general media about the connection between Prozac and acts of violence.

It should be noted that in several studies, the findings suggested that Prozac did not lead to suicidal preoccupation or found that the drug was not associated with an increased risk of suicidal acts. Other reports on clinical experiences with Prozac and its effects following an overdose support the safety of the drug.

However, other research supports the contention that Prozac leads some users to become suicidal or violent. In his book, Dr. Breggin says that it is the drug's ability to cause a variety of psychological and neurological disorders that underlies such destructive behavior. Five of these disorders--agitation, panic, anxiety, mania and akathisia--can prompt suicidal or violent acts, says Breggin. Four other conditions caused by Prozac--depression, paranoia, obsessive-compulsive thoughts and behavior, and insomnia--may precipitate the irrational fears, suicidal thoughts and despair that lead to violent thoughts or actions. 

Next:  What can you do if you've had a bad reaction?  

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