6/21/2000 – A Dark Side to Prozac?

This story has been posted on ABC News.com, after tonight’s
20/20 Show and Dr. Glenmullen’s appearance on the ABC News

A Dark Side to Prozac?
New Study Concludes Drugs Like Prozac May Induce Suicidal

Selective Serotonin Reuptake Inhibitors (SSRIs) have helped
millions who suffer from depression. But, ask some medical
professionals, can they have potentially serious side effects?

By Rebecca Raphael

June 21 — In the winter of her freshman year at Harvard
University, Julie was prescribed Prozac to treat depression. But
instead of helping ease her symptoms, she says the medication
made her feel worse.

Almost immediately after taking the drug, Julie says she began
having trouble sleeping. Within a week, she says she felt
agitated and detached from the world around her.
“I couldn’t stand how I felt,” says Julie, who asked that her
name not be used. “It’s like 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

About a month after she started taking Prozac, Julie proceeded
to overdose on over-the-counter sleeping pills. “I couldn’t think
about my family; I couldn’t think about my friends,” she says.
“All I
could think was, I have to get out of this feeling.”
Julie says she had never before felt suicidal. “I knew that the
suicidal feelings had not been there before I started Prozac, I
remember that very distinctly,” she says. “I’m a very hopeful
person, despite having been depressed, and it’s a really
disconcerting thing to suddenly feel suicidal and not really be
able to explain why.”

After her suicide attempt, Julie was admitted to the psychiatric
ward of McLean Hospital in Massachusetts, where doctors notes
suggested that she had had a “paradoxical reaction to Prozac.”
Julie believes that the Prozac was the cause of her suicidal
feelings. 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 what is
called “akathisia,” an extreme form of agitation.

“I’m on record as saying that SSRI-type antidepressants like
Prozac and Zoloft can make people suicidal,” he says.
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). It is now estimated that one out of eight
Americans has taken at least one of these drugs and the
suggestion of a connection between SSRIs and suicide is
raising controversy among doctors, patients and manufacturers
who are involved in the $6-billion-a-year market.

A Causal Link to Suicide?
In his most recent study, Healy took 20 healthy, non-depressed
volunteers and put them on Zoloft, an antidepressant that is
believed to work, like Prozac, by boosting serotonin levels in the
brain. Two of volunteers became suicidal. Healy believes it was
the Zoloft that caused akathisia, a combination that he says can
occur in some people during the first weeks of treatment.
But manufacturers of these drugs deny any causal relationship
between SSRIs and suicidal behavior. “The data that we’ve
reported is quite overwhelming that this drug is not associated
with increase in suicidality,” says Dr. Steven Paul, vice president
of clinical investigations at Eli Lilly, the maker of Prozac. “The
over 10,000 patients that 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.”

Even critics like Healy agree that for some patients, these drugs
can be highly beneficial, which is why he continues to prescribe
SSRIs, including Prozac and Zoloft, to patients, though with
careful monitoring.

But, says Healy, based on his study, it is the rare cases that
concern him. “The conclusions are that these drugs can directly
cause people to commit suicide,” he says.
In a letter to 20/20, Pfizer, the maker of Zoloft, attacks
conclusions saying that there is “a vast body of valid medical and
scientific research” refuting his theory. Pfizer claims that there
was no reliable evidence that Healy’s subject’s 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 shares numerous anecdotes
about patients who experienced dramatic changes, including
anxiety, agitation, insomnia, suicide attempts and violence
toward others.

“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 tells 20/20’s Dr. Nancy Snyderman.

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 unknown to many, transcripts
from the same FDA hearing show that three of nine panel
members expressed concerns about the data and were not

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.

Despite these 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.” But, he says, they need to be aware of the potential
risks and monitored closely. Experts also warn that SSRIs
should not be discontinued without first consulting a doctor.
Glenmullen 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 withdrawing from Harvard, Julie 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.

Despite her belief and affirmation from some members of the
medical community that Prozac may have caused her suicidal
feelings, she says that for some people, antidepressants can be
a lifesaver. Though Julie ultimately would like to see
manufacturers include information about the side effects, she at
least 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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