Finally after all these years of working to get this information to
an unsuspecting public, the New York Times is reporting what I
have been writing about, lecturing about, testifying to, etc. all of
this time—that the SSRIs (Prozac, Zoloft, Paxil, etc.) work like
As I say on the front of my book `Prozac: Panacea or Pandora?,”
“Turning the 90’s upside down to relive the 60’s.”
This group of drugs was introduced by the same drug company
that gave us LSD, Eli Lilly Pharmaceutical!
Dr. Howard Markel deserves a medal for getting this critical
information to the New York Times. I urge all of you to get this
New York Times article to your local media and get them to
reprint the article. I am sick of seeing so many die or have their
lives destroyed because the media is not printing the truth about
these dangerous drugs.
Ann Blake-Tracy, Executive Director,
International Coalition For Drug Awareness
October 24, 2000
Cases: Easy Answer May Not Be the Right One
By HOWARD MARKEL, M.D.
About the Author
Dr. Markel is an associate professor of pediatrics and
communicable diseases and of history at the University of
Steve is a 17-year-old with a scraggly goatee, a propensity to
wear Grateful Dead T- shirts and a strange medical complaint. A
few months earlier, in response to symptoms of clinical
depression, I had placed him on Prozac, a selective serotonin
reuptake inhibitor, known as S.S.R.I.
Although he no longer complained of sadness, poor
concentration and boredom, the problems that gave occasion to
his being prescribed Prozac, he was now experiencing frequent
disturbances of color and occasional moments when people he
was looking at transformed into cartoonlike figures.
Unfortunately, I paid too little attention to his complaint and
reflexively reached for my prescription pad to switch his
medication from Prozac to Zoloft, the equivalent of switching from
Coke to Pepsi, hoping that a different S.S.R.I. might solve the
problem. Because these episodes weren’t particularly
distressing to Steve, we agreed to see each other within a
month. But my therapeutic intervention accomplished nothing,
and, again, I switched him to still another S.S.R.I.
At a later visit, Steve admitted that until seven months ago, when
he was caught selling pot at his high school, he had been a
“garbagehead.” In teenage parlance this means that whatever
drug he came in contact with ˜ alcohol, marijuana, Ecstasy,
over-the-counter cold remedies, you name it ˜ Steve consumed
it, and often daily.
But for the past few years, his drug of choice was LSD. Until he
was arrested and required to enroll in a strict drug abstinence
program, Steve tripped weekly. When we met, he had been clean
for about five months but the episodes he was complaining
about reminded him of “when I was tripping on acid.”
Doctors who treat adolescents deal with drug abuse almost as
often as other pediatricians encounter ear infections; but Steve’s
LSD use was particularly troubling because, like many
physicians, I had little experience recognizing or treating the
problems that can result from it Indeed, before meeting Steve,
LSD was more of historical interest to me than practical or
clinical value: a quaint relic from the flower-power era of the late
1960’s and early 70’s.
As a matter of fact, LSD is again emerging as a serious concern
to pediatricians and parents alike. According to the Monitoring
the Future Study conducted by the University of Michigan’s
Institute for Social Research, the rates of lifetime, annual and
current use of LSD among 8th, 10th and 12th graders have
gradually increased since 1990.
Although LSD use reached its peak in 1996, during 1999, about
12 percent of American high school seniors used LSD at least
once and more than 8 percent of them used it at least annually.
More alarming, about 3 percent of these young adults tripped
There are many reasons to avoid LSD, but one of the most
distressing side effects that can result from its chronic abuse is
the flashback syndrome. Flashbacks are recurrent hallucinatory
episodes that are not associated with the presence of the drug
in the brain and may occur months to years after stopping its
use. I wondered if this phenomenon might explain Steve’s
In the weeks that followed I began to inquire more closely about
the LSD use of other patients I treated for depression with
S.S.R.I.’s. Soon enough three more teenagers admitted to
having used LSD and while none of them had used the
hallucinogen for many months, all began to experience
flashbacks only after initiating treatment with an S.S.R.I. agent.
One patient, an 18-year-old named Lisa, described a few
flashbacks that, unlike Steve’s almost humorous experiences of
watching his teachers transform into Pokemon characters, were
upsetting and debilitating. When I queried these teenagers why
they had not complained to me before about the flashbacks,
each had the same response: you never asked!
Concerned about these four teenagers, I left my clinic one
evening and headed straight for the stacks of the medical library.
When armed with a novel clinical experience this can be one of
the most exciting places on earth for a doctor to conduct a game
of medical detective. Before the night was over, a Eureka-like
moment was to be had.
Serotonin reuptake inhibitors, as their name implies, prevent the
reabsorption of this neurotransmitter from the synapse, the gaps
between two neurons that rely on chemicals like serotonin,
dopamine and norepinephrine to communicate with one
another. Although the exact mechanism for depression remains
unclear, many students of psychiatry say a central role may be
played by abnormally low levels of serotonin in the brains of
depressed people. This theory is supported by the miraculous
impact S.S.R.I.’s have had on millions of Americans who suffer
from what the ancient physicians called melancholia.
Excitedly leafing through the literature on LSD, I learned that the
hallucinogen not only increases serotonin levels in the brain, it
also has a special affinity for many of the same neuroreceptors.
The likely mechanism, then, for my patients’ new onset of
flashbacks was that the S.S.R.I. agents I prescribed were not
only yielding an increased concentration of serotonin in their
central nervous systems but were also overstimulating their
serotonin receptors. Within months of discontinuing the
S.S.R.I.’s, all of the teenagers’ flashbacks ended but could return
unpredictably. Happily, these teenagers all, thus far, remain
clean and sober and free of depression.
After consulting with several pharmacologists who specialized in
the effects of LSD on the brain, we presented these four
teenagers’ cases to my colleagues and ultimately published
their cases in The Journal of Pediatrics to alert others who care
for adolescents with a history of both depression and LSD
abuse. But for me these exercises were more a lesson in
humility than a proud accomplishment.
Steve and other patients who experienced flashbacks, perhaps
as a result of prescriptions, taught me two valuable clinical
lessons: a simple solution to a complex problem has the
potential to worsen things; and, often a patient hands you the
correct answer but the key is figuring out the right question.