A Dark
Side to Prozac?
New Study
Concludes Drugs Like Prozac May Induce Suicidal Behavior
By Rebecca Raphael
June 21
— In the winter of her freshman year at Harvard, Julie, who
requested
anonymity, was prescribed Prozac to treat depression. Almost immediately
after taking the drug, Julie says she began having trouble sleeping, and
within a week, she says she felt agitated and detached.
 |
|
Steven Kazmierczak, the gunman who killed five students at Northern
Illinois University in mid February 2008, was taking anti-depressants
(Prozac), anti-anxiety medication (Xanax)
, and a sleep aid (Ambien), his girlfriend said.
(AP)
|
“I
couldn’t stand how I felt,” she says. “I wanted to crawl out of my skin. It
was just terrible. I felt so terrible that I just thought, I can’t live like
this … I couldn’t think about my family; I couldn’t think about my friends.
All I could think was, I have to get out of this feeling.”
About a month after she started taking Prozac, Julie overdosed on
over-the-counter sleeping pills. When she was admitted to the psychiatric
ward of McLean
Hospital in Massachusetts, her doctors noted that she'd had a “paradoxical
reaction to Prozac.”
Julie has a differing — and more blunt — appraisal: She says the drug
was the cause of her suicidal feelings.
“I knew that the suicidal feelings had not been there before I started
Prozac. I remember that very distinctly,” says Julie.
According to a new study by Dr. David Healy, director of the North
Wales Department of Psychological Medicine in Northern Ireland, Julie may
not be alone in experiencing an extreme form of agitation called akathisia.
Healy’s study is one of the most recent that claims there are potentially
dangerous side effects for some patients on the class of antidepressants
called Selective Serotonin Reuptake Inhibitors (SSRIs).
“SSRI-type antidepressants like Prozac and Zoloft can make people
suicidal,” he says.
A
Causal Link to Suicide?
In his most recent study, Healy put 20 healthy, non-depressed volunteers on
Zoloft, an antidepressant that is believed to work, like Prozac, by boosting
serotonin levels in the brain. Two of the volunteers became suicidal.
“The conclusions are that these drugs can directly cause people to
commit suicide,” he adds.
It is estimated that one out of eight Americans has taken at least one
of these SSRIs, so the suggestion of a connection between these drugs and
suicide is raising controversy among doctors, patients and manufacturers
involved in the $6-billion-a-year market.
“The data that we’ve reported is quite overwhelming that this drug is
not associated with an increase in suicidality,” says Dr. Steven Paul, vice
president of clinical investigations at Eli Lilly, the maker of Prozac. “The
over 10,000 patients who have been on clinical trials where people have
looked at suicidality, suicidal ideation,” he adds, “have shown without a
doubt that these drugs do not increase suicidal ideation or suicide
potential. In fact, they do just the opposite: They reduce it.”
Pfizer, the maker of Zoloft, says there is “a vast body of valid
medical and scientific research” refuting Healy’s theory. Pfizer claims that
there was no reliable evidence that Healy’s subjects were “healthy” to begin
with, and calls the study’s conclusions “scientifically bogus, false and
misleading.”
Still, Healy does have his supporters. Dr. Joseph Glenmullen, a
clinical instructor of psychiatry at Harvard
University Medical School, who recently wrote Prozac Backlash, points
to a 1990 study that says Prozac can induce “intense, violent suicidal
preoccupation.” In his book, he also presents numerous anecdotes about
patients who experienced dramatic changes, including anxiety, agitation,
insomnia, suicide attempts and violence toward others after taking SSRIs.
Akathisia is only one of many potential neurological side effects.
Glenmullen says a significant number of people can experience other
problems, like fatigue, muscle spasms, sexual dysfunction and withdrawal
syndromes.
“We now have unequivocal evidence from a wide range of side effects
that these drugs are impairing the normal functioning of the brain and
that’s information doctors and the public need,” Glenmullen says.
Critics of Glenmullen’s book point to a 1991 FDA study that found there
to be “no credible evidence of a causal link between the use of
antidepressant drugs, including Prozac, and suicidality or violent
behavior.” But transcripts from the same FDA hearing show that three of nine
panel members expressed concerns about the data.
Despite what he believes to be potentially harrowing side effects,
Glenmullen says, “For moderate to severely depressed patients or with other
conditions that they’re used for, the drugs can be enormously helpful and
you see patients have clear-cut responses to them and really benefit from
them.”
Healy, too, agrees that these drugs can be highly beneficial, which is
why he continues to prescribe SSRIs, including Prozac and Zoloft, though
always with careful monitoring.
What patients need, says Glenmullen, is to be aware of the potential
risks and to be monitored closely while on the drug. He has petitioned the
FDA to add a warning to the labels of SSRIs alerting doctors and the public
to akathisia, suicidality and other side effects.
“This is an urgent public health concern given the tens of millions of
people, including children, being prescribed SSRIs,” he writes.
‘They Need to Know’
After her release from the hospital, Julie withdrew from Harvard. She
returned the following year and graduated. Now married and in her final year
of law school, she says she has overcome her depression and put her life
back together.
Julie believes her ordeal could have been avoided if the doctors
treating her had been aware of the possible link between the medication and
suicidal thoughts. In her case, one psychiatrist had taken her off the
medication, suspecting that Prozac was the cause of her suicidal feelings,
only for another doctor to reject that theory and put her right back on the
drug.
She would like to see manufacturers include information about such side
effects and hopes that her experience can serve as an opportunity to
increase public awareness.
“Prozac is a great drug,” she says. “People should take Prozac. It can
help people. But there are some people it’s not going to help, and there are
some people whose lives it could ruin. And they need to know.” 
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