I can’t lie; I have always been intrigued with the concept of a “happy pill.” Like all other stereotypes that we all shamefully believe, depression has lived within every persons reach for decades. In a society where we are all constantly losing weight, gaining weight, oversleeping, under sleeping and kept far away from dreaming- it’s hard not to question the boundaries of “depression.” The mental illness seemed to have a certain persona in the 80s, when the government first approved SSRIs. Merely 27 years later, and we see 1 in every 10,000 person in the US was prescribed antidepressants admitted for depression. 1 in 5 of us humans will be depressed over an entire lifetime, and shockingly 1 in 10 pregnant women are on antidepressants as well. Shortly after the pills became on the market, over 6 million Americans were taking an antidepressant- along with 6 million Europeans. So it’s easy to question the human species in general, and whether or not each and every one of us is depressed.
Prozac
So what has Prozac done for us exactly? Lots, and probably more than you would ever know. The young & depressed had no voice or meaning before Prozac, and everyone was considered a drama queen. Those severely struggling with depression saw Prozac as the Holy Grail, and many cases have changed people’s lives in no way but positive. Prozac shed light on the darkness millions were living through each day, and made life easier and clearer.
My curiosity expanded with depression once I was enlightened with the allusion of a Prozac Nation. It was the year of 1996 that Elizabeth Wurtzel dazzled teens with her masterpiece memoir. Soon it was turned into a film, and teens everywhere seemed attracted or rejoiced by the concept that everyone is depressed.
The typical approach when questioning an entire human race is usually philosophical. The classic, “human beings can’t truly love anyone because they will never really love themselves,” perspective to the hollowness of our species. Friedrich Nietzsche himself once quoted that, “The thought of suicide is a great consolation: by means of it one gets through many a dark night.” Like other famous philosophers, poets and cultural critics, his beliefs and accusations of humanity only really developed into an art- not so much an answer.
However, when it comes to the antidepressants themselves, the only way to get a clear answer may be to approach the questions from a medical perspective. In retrospect, it may seem too ironic to ask any doctor about medications, so instead I asked Dr. James Fairlamb. Specializing in cardiology, James has affiliation with multiple hospitals including the Boone Hospital Center and Bothwell Regional Health Center. With twenty-two years of experience, James is also on the American Board of Internal Medicine. His expertise on patient centric practice models and cardiovascular rise management made me believe that he would be able to shine light on my Prozac puzzle.
Before we began the actual interview, James explained to me that the root to most people’s depression was something called hedonism. Hedonism is an ethical theory that pleasure is the highest treasure in human life. Once our hedonism seems to fade or disappear, and things that once made us happy don’t have the same impact, it throws the entire aim of our life into question.
- Why was Prozac(replace this word with SSRI’s) so impactful on Society?
Jess , like any advancement in medical science Prozac has had a significant impact on the practice and prescribing habits of psychiatry. The proper/Generic name is Fluoxetine and it was discovered , along with other drugs in the same class called Selective serotonin re-uptake inhibitors or SSRI’s in the mid 70’s after research done mainly in Basel Germany by a Dr Paul Kielhotz who had an interest in depressive disorders. It was discovered along with other medicines that affected mood by studying how older drugs(called Tricyclic anti -depressants or TCD’s and Mono-amine Oxidase inhibitors or MAOI’s ) worked. It was approved by the American Food and Drug agency (The FDA) in 1988 after a fairly long process for use in people with mild to moderate levels of depression.
Other SSRI’s include Paxil (Paroxetine) , Zoloft (sertraline),Effexor( Venlafaxine ), Celexa(citalopram). All these drugs appear to increase the amount of a neurotransmitter in the brain called Serotonin by blocking the pathway that re-absorbs this into the neurons(brain cells) . In short lots of Serotonin gives us a bit of a “high” and we feel happy ….hence the dawn of “Happy Drugs”.
Prozac specifically was very heavily, and very successfully , marketed as a drug with fewer side effects and monitoring requirements than older alternatives and it could be given once a day. The possibility of side effects was probably downplayed.
- 2. If you aren’t prescribed an antidepressant, are you really diagnosed with depression?
This question is analogous to the question if you aren’t treated for advanced cancer can you still die from it ? Of course you can have depression that isn’t treated with medicine , sometimes this is better , sometimes worse depending on the specifics of the case.
- What really is Prozac?
Prozac began it’s life in the early 70’s as a compound called LY 110410 (LY stands for Lilly , the developing pharmaceutical company) , and was later named Fluoxetine , it’s official Trade name . It is one of the first of a growing class of medicines called SSRI’s (See above)
- What are the most common side effects from Prozac?
Like any drug the risks and benefits need to be weighed , Most people who take this drug feel better for it if it is prescribed in the correct patients . However some , even if getting the drug appropriately, may have one or more of this “list of horribles” : Suicidality , worsening depression ,being “hyper” (Called mania) , Low sodium levels siezures, low glucose levels , a weird syndrome that involves involuntary jerking and decreased leve;l of consciousness called “serotonin syndrome” , Rash , cardiac abnormalrhythm, scarring in the lungs , an erection that wont go down, increased pressure in the eyes, withdrawal syndrome if stopped abruptly , low blood pressure , possible problems with babies born to mothers who take this drug during pregnancy. Nausea , lack of appetite with weight loss, dizziness , diarrhea , inability to ejaculate in men, ‘flu like syndrome , decreased interest in sex , and there are more…..
- 5. How would a doctor usually define or score someone as depressed?
Like I said on the phone yesterday the final diagnosis of depression is subjective both on the side of the Doctor and the side of the patienyt , most good doctors don’t “just wing it” when it comes to making this diagnosis but use a scoring method of some type. The most common is called the “PHQ-9” form which I have attached with instructions on how it is scored
- 6. Would you say there have been a lot of people prescribed Prozac in the passed decade, who don’t need it?
YES undoubtedly , and likely many people who may benefit from SSRI’s who don’t get them prescribed as well. Medications are helpful for people with disease , they likely should not be used in people with normal range human emotion such as being “depressed” after the death of o loved one or the ending of a relationship or normal “work stress” ….these are NORMAL and should not usually be treated as disease. It IS NOT NORMAL to feel “up” the whole time , just as it is not normal to feel “down “ the whole time. When depression starts to significantly impact ones life in a negative way then we need to try and quantify, as best we can, that problem and consider treating it. See the PHC9 form above.
- What are your personal thoughts on Prozac itself? And how does it compare to any other antidepressants? (Zoloft, SSRI’s)
Prozac(fluoxetine) is like any other tool in a carpenters tool belt , sometimes a small Phillips head screw driver is the best for the Job , sometimes a larger flat screw driver , and sometimes a wrench or a hammer . Just as asking a carpenter which is his/her favorite tool will likely result in a response that sounds something like “for what job?” Prozac can be the right answer depending on the situation .
- Do you find people using the title “depressed” as an excuse to get a prescription?
Not usually , more likely who are “pill shopping” go for other things with a more pronounced and immediate high like pain killers in the Opiate class , and recently drugs used for ADHD
- Do you think people can be “depressed” if they are NOT prescribed an antidepressant?
This question is analogous to the question if you aren’t diagnosed with cancer can you still die from it ? of course depression is very very VERY frequently missed by their doctors . mainly because of the stigmna associated with the idea of “Mental Illness “ that accompanies it
- Do you think that Prozac, (or any other medication), was created in order to give depression a proper diagnosis?
No .
- If antidepressants are made to “numb the pain”, does it every really go away?
Good question . also one that is better answered by philosophy that medicine , read Albert Camus , Jean Paul Satre or Soren Kierkegaard on second thoughts don’t , if you weren’t depressed when you started reading them you probably will be after you do. The same question could be asked of morphine after you have been shot probably with the same answer.
- Have you ever heard of someone who was “born depressed?”
If the question is can depression be constitutional or inherited the answer is yes. But some folks function at this level very well and , ironically , just aren’t happy unless they are a little depressed ….go figure.
- Do you think that depression is something that is avoidable or curable?
Depends on what you mean by depression , depression is a normal part of human emotion and as such is unavoidable and not something that requires curing. On the other hand , disabling severe clinical depression is not normal and does require help , sometime with medicines occasionally with other non-pharmacologic modalities. In the vast majority of cases we can make a huge difference in people lives if we identify and treat depression when it is needed.
- Do you think every human being faces depression at one point in their lives?
Read up on cyclothymia and bipolar disorder; everyone has minor up’s and downs , that is normal. People who don’t aren’t people , they are robots (and assholes) , when this gets a little crazier it’s called cyclothymic disorder , and when it really hits roller coaster level it is called Bipolar disorder (also called manic depressive psychosis)
- What do you truly think the proper definition of depression is?
See PHQ9 attached
SO there you have it. Maybe it’s the one with the chemically imbalanced brain? Or the guy guilty of the dark poetry on the bathroom stall, or even the heart-broken girl wearing leather pants in Starbucks… Maybe it’s everyone who is clinically depressed. Or maybe it’s no one.
After analyzing the simplicity to a concept so vast, I rationalized that no human being is born with a fever of depression- we are all open to the same diagnosis. It seems that we ourselves aren’t what’s so depression and pill praising about society, but it is our environment. The air we are breathing is in a way making us all sad and sick inside, but that may just be because we are all trying to breathe someone else’s air. Our own pursuits of happiness get derailed and fed up in ways that majority of our own species won’t ever understand.
And that is the answer.
