Let Them Eat Prozac

The author shows how the pharmaceutical industry goes to great lengths to hide evidence of harmful side effects and even goes after doctors and others like the author who dare to speak out to warn people about the dangers of antidepressant drugs.

Below are quotes from the book, which speak for themselves.

The depression campaigns had a twofold strategy. One was to alert physicians and third-party payers in health care to the huge economic burdens of untreated depression. The campaigns were so successful in this strategy that a decade later no one bats an eye at claims that depression is one of the greatest single health burdens on mankind. But no one asks whether treatments that are supposed to make a difference actually do produce benefits. There is plenty of evidence that antidepressants can be shown to do something in the short term but almost no evidence that things turn out better in the long run, and there are many reasons to worry that we might be making things worse. Something must surely be going wrong if the frequency of depression apparently jumps a thousand fold since the introduction of the antidepressants. (page 9-10)

It is often said that a psychiatric drug can never be said to cause suicide because patients are already at risk of suicide from the nervous condition for which they are being treated. Reserpine demonstrates the superficial nature of this response. None of the people who committed suicide on reserpine had a nervous problem- they were all hypertensive. (page 15)

Far from the problem being simply one of dependence that emerges on withdrawal from the drugs, the SSRIs produce what may be more appropriately termed "stress syndromes." Unlike insulin or thyroid hormone, which are replacements for a deficiency, the SSRIs are alien chemicals and, as such, are brain stressors. The consequences of this stress become apparent in some individuals on drug withdrawal, when the system attempts to regain equilibrium. But in others, the stresses can be visible during the course of treatment. (page 29)

For those who believe that approval of a drug by the FDA means that it is in some sense good for you if taken properly, the situation is even more problematic than the above scenario might suggest. "Two positive studies" doesn't mean the drug works for depression in two studies. It means there are two studies in which the drug can be shown to have an effect on depression- can be shown to do something. Whether it is a good idea to take any of these drugs is not addressed. In other words, these trials do not offer evidence the drug works in the sense that most people mean by the word works- that is, evidence that this drug clears the problem up. (page 36)

There is a key point to take from all this. We are accustomed to the notion that our regulators are looking after us, that they are acting in some sense as consumer watchdogs. But this is not their role. The role of a regulator is to adjudicate on whether, for example, a yellow substance in front of him or her meets minimal criteria for butter; to ensure, for example, that it is not lard injected with color. Regulators are not called upon to determine whether this butter is good butter or not, or whether butter is good for your health. Consumer watchdogs must do that. Within medicine, the physician is supposed to be the consumer's watchdog- which, given that they rarely consume the product, makes for an ambiguous and commercially unique situation. (page 37)

Nevertheless, there is a solid literature on antipsychotics making patients suicidal or homicidal. No one denies that this can happen. Indeed, Lilly and other companies from 1997 were to see their new, atypical antipsychotics on the basis that they caused less akathisia and were therefore less likely to make patients suicidal than older antipsychotics. Given that Prozac had been noted right from the start to cause dysphoria and agitation, it was hard to see how Lilly or anyone else could deny it might also lead to suicide or homicide. (page 84)

These clinical trials made it possible to estimate how many people had made suicidal attempts because of Prozac. It ten per thousand make an attempt on Prozac and five per thousand or fewer do so on placebo or other antidepressants, and if (as conventionally estimated) forty million people worldwide have had Prozac, then there will have been two hundred thousand more suicide attempts on Prozac than had Prozac not been used. Conventional wisdom is that there is one suicide for every ten attempts. These would give twenty thousand suicides over and above the number who would have committed suicide if they had been left untreated or been treated with older agents. (page 171)

But what about Britain's postmarketing surveillance systems, supposedly superior to the FDA's Adverse Events system? Here another surprise waited. Inquiring in emergency departments, I found that a standard exchange went as follows:

Q. Do you guys recognize that among the suicide attempts you get, there is a group of people who come in after a first overdose or suicide attempt, who simply aren't chronic parasuicides?
A. Yes.

Q. Do you have any sense that these patients are much more likely to have recently been put on an SSRI than any other kind of antidepressant?
A. Yes.

Q. What do you do about their antidepressant?
A. We send them home and tell them that this shows the drug is working. It's kicking in.

This disastrous advice explained why surveillance schemes weren't picking up a warning signal. There wasn't  much point in reporting that the drug was working. Lilly played some part in this. It had been telling primary-care practitioners for some time about something called serotonin pickup syndrome -a new term to me. But the point behind telling primary-care physicians about this was that if they didn't warn the patient, the patient might stop treatment. Lilly was warning people not in order to minimize hazards but in order to keep patients from going off Prozac. (page 172)

One man on Zoloft I treated memorably described a loss of concern for others. Normally he would help older women having trouble crossing the road, but on Zoloft he found himself much more likely to walk past them. Since I was prescribing Zoloft frequently, similar cases often came my way. In one, a sophisticated professional described a split within himself, part of him consciously watching the more instinctive side. He found he was having to intervene much more deliberately than usual to stop himself doing socially unacceptable things - such as bludgeoning to death kids he caught trying to break into his car. This seemed to lie midway between disinhibition and blunting. (page 175)

Back to Book Reviews