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Doctor responds to Prozac warnings

(Mon. April 17, 2000) -- The recent articles in The Star concerning Dr. Joseph Glenmullen's new book Prozac Backlash deserve a response.

The second of these articles describes Eli Lilly and Co. physician Stephen Paul as suggesting that the author may be out to make a name for himself.

I'm in no position to know what Glenmullen's intentions are. He may well be doing what he thinks is right. So was Timothy McVeigh.

Not that I think Glenmullen is another McVeigh, but you get my point.

Sure, the antidepressants (there are 23 of them on the U.S. market now) can have side effects. Sure, there are reports in the psychiatric literature every month of patients who experience significant health problems while taking antidepressants (though these occurrences don't always mean the medication caused the problem). Sure, these medications at times lose some of their efficacy after a period of full effectiveness.

So what's new? All drugs can have side effects. People die from penicillin and people get Reye's Syndrome from aspirin. After a period of time at the same dose, blood pressure, heart and gastrointestinal medications can also "poop out." This happens every day, and the doctor-patient team then makes the necessary adjustments.

To write a book, as Glenmullen did, emphasizing such negatives to the general public is a careless thing for a psychiatrist to do. To write that these medications "may effect a 'chemical lobotomy' by destroying the nerve endings they target" is flat-out irresponsible.

Glenmullen exaggerates, and this sensationalism may frighten people who need these antidepressant medicines as much as diabetics or asthmatics need their medications.

There is one completed suicide in the United States every 20 minutes. People suffering from depression, and obsessive-compulsive disorder and other disorders, are more likely to get better with the combination of medication and non-pharmacological therapies; treatment doesn't have to be just one or the other.

To opine that 75 percent of patients in his experience are needlessly on these drugs may be based on the type of patient Glenmullen usually sees or in his personal bias, but it certainly isn't based on any scientific study.

An alternative to Glenmullen's book is The Antidepressant Sourcebook: A User's Guide for Patients and Families, released in January by Doubleday but without the sensationalized fanfare. I am the author. Like Glenmullen, I am independent and receive no stipend or research grants from any pharmaceutical company. I am a past president of the Indiana Psychiatric Society.

Finally, there are 56 pages of references in the Antidepressant Sourcebook, most of which are scientific articles, texts and double-blind, placebo-controlled studies, not anecdotal case reports.

The antidepressants can vastly improve, and even save, the lives of many people whose current depression is untreated. The positive effects of these medications far outweigh their potential negative effects. It's too bad the potential negative effects get far more public attention than their positive effects.

My fear is that the negative effects of Glenmullen's book will far outweigh whatever positive effects he hopes to accomplish. I can only hope that "one bad apple" won't deter people from receiving a proven, safe, effective medical treatment.

Dr. Morrison, of Indianapolis, is a staff psychiatrist at St. Vincent Stress Center.

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