Mrs. Marcus asked her reluctant husband to come to therapy with her. He had been taking Prozac for several months and considered himself a kind of poster boy for the drug. He often told his friends and acquitances how much it helped him and on one occasion had participated in a radio show with his psychiatrist to promote the drug.
As soon as he sat down in my office, it was obvious that Mr. Marcus was emotionally blunted and remote. He showed little expression and his voice lacked timbre [A sound of distinct pitch and quality: tonality, tone].
“You look kind of flat to me,” I said. “How do you feel?”
“I’m glad to be rid of feeling so bad,” he answered.
We talked for a few minutes about what it meant to feel “so bad.” It was hard for him to express himself but much of it surrounded conflicts with is wife and hi previous wishes to get divorced.
“Does you psychiatrist notice that you’ve lost your spark?” I asked.
“I only see him for fifteen minutes every six weeks or so. I tell him I’m doing good and he writes me the prescription.”
“He was never like this before,” his wife burst out. “He used to be full of energy and vitality. He’s only fifty, but he looks and acts like an old man. He seems more depressed to me. I even called his psychiatrist to tell him, and what did he do? He raised my husband’s dose.”
After a long pause, she blurted out, “We haven’t made love in months!”
He shrugged and then said, “But we don’t fight so much anymore. I couldn’t stand the fighting. We were getting nowhere.”
“We’re not getting anywhere now,” she explained sadly. “he knows this,” she explained, “and I’ve been thinking of leaving. I can’t stand to see him this way and it’s making me feel like I’m not worth anything.”
Mr. Marcus agreed to continue coming for therapy “for the sake of the marriage.”
With his wife’s encouragement over he next several weeks, he agreed to try gradually reducing his daily Prozac by one-third from 60 to 40 milligrams. Within a few weeks after the reduction, he began to brighten up. He asked for another reduction and then for an end to the medication. Within a few months, he felt like himself again for the first time since starting the medication.
Mr. Marcus found that even his memory function and his ability to think had been clouded on the drug without his perceiving it. In retrospect he saw that he not only lost his sex drive, he lost his interest in his wife and in almost everything everyone else he cared about, when he was on the SSRI. He and his wife were making love again and arguing again, but now they were dealing with their conflicts in a couples therapy and their life together was improving.
Impairing Our Self-Perception
Psychoactive drugs impair our ability to evaluate our own performance or experience, so it is easy for people t fool themselves about the benefits under their influence.
Remember the advertising campaign that urged us to stop drunken friends from driving by taking away their car keys? It’s a good idea, of course, except that the inebriated friend is likely to resent us. People under the influence of alcohol tend to think they can drive as well as or even better than ever. Similarly, people who use alcohol or recreational drugs may believe at the time that they are improving their social and romantic life, but in reality they are relating in a superficial and sometimes foolish manner that’s obvious to anyone who is not intoxicated.
After people stop taking recreational drugs or alcohol, they often realize in retrospect that the improvement in sex or in social relationships was illusory. The drugs or alcohol were covering up the superficiality or even the hostility and conflict in the relationships.
Although people taking SSRI antidepressants are not likely to believe or to claim that the drugs have improved their sex life, they are likely to minimize the devastating effects on their sexual function and on their love and family life. Their partners, like Mrs. Marcus, are most likely to tell the doctor about the problems created by the drug treatment.
Love and the Brain
Love requires a fully functioning brain. From alcohol and marijuana to psychiatric drugs, any psychoactive agent in the long-run will dull awareness and disrupt intimacy. All psychiatric drugs can impair sensitivity, empathy, and caring, and as a result they can impair sexual experiences. As described in Chapter 4, SSRIs cause hormonal dysfunctions that directly impair the ability to experience or enjoy sex. In regard to impairing sex and love, SSRIs are in fact much worse than the most psychoactive substances. Sexual dysfunction is a frequent SSRI effect.
Depression and Suicide Caused by Antidepressants
Tally was a very bright, energetic woman who felt, if anything, that she ad too much vitality. She was at times like a St. Bernard pup, trampling on people’s feelings without realizing and barging into situations at work without thinking first. But her spontaneity and her lack of restraint endeared her to loved ones, including her boyfriend, and made her an excellent manager of people at work.
She had come to see me with her boyfriend to work out some difficulties before they got married. During the therapy, she went on vacation and suffered a skiing accident that resulted in considerable persistent physical pain in her back and neck. In an effort to control the pain, her orthopedic surgeon prescribed the SSRI Zoloft for her.
Tally had been on 100 milligrams of Zoloft for about six weeks when she decided it really wasn’t helping her pain. If anything, she was beginning to feel depressed for the first time. She attributed her feeling “blue” to her pain and to her lack of exercise, and not to the Zoloft; but with little evidence that Zoloft was helping, she decided to cut back on it.
The next day Tally’s boyfriend called me and told me that she had reduced her Zoloft from 100 to 50 milligrams the day before, and that now, for the first time ever in her life, she was in a “black hole” and actively thinking of killing herself.
Tally and her boyfriend were in my office within hours. Nothing had happened in the last few days to make her feel so hopeless and despairing. The pain was no worse. She was able to carry on her life and even sleep well at night with moderate amounts of painkillers. She couldn’t give any explanation for why she wanted to die, but the feeling persisted.
Tally rejected the idea that she was “crushing” from the reduction in her medication. As someone who prided herself in taking charge of her own life and being responsible, she argued that “a drug can’t control my feelings.” Nonetheless, she agreed to resume the 100-milligram dose of Zoloft and within an hour or two she felt like her normal self again. That convinced her she had been doing through drug withdrawal.
Tally asked me to take over the prescription of her Zoloft and under careful supervision by me and her boyfriend, the drug was tapered and then stopped over a two-week period without any negative consequences.
Tally’s story ended well in part because of my awareness of the tendency of SSRI antidepressants to cause suicidality, sometimes as a direct effect and, as in Tally’s case, as a withdrawal reaction. Many other doctors, in my experience, would have increased her drug dose on the grounds she needed more of it. Or they would have added a second antidepressant that could have worsened her condition. I have been a medical consultant in many cases in which Prozac and other SSRI antidepressants have caused or contributed to suicide and to violence. If the FDA had been more responsible, these continuing tragedies could have been diminished in number or avoided. Psychiatrist Richard Kapit anticipated them when he was the chief medical officer at the FDA in charge of reviewing the dangers of Prozac prior to its approval.
The FDA Knew from the Beginning
When I began my review of the FDA documents as a medical expert in product liability suits against Eli Lilly and Co., I was shocked and disillusioned by what I found. Until that time, I had not fully confronted the willingness of the FDA to protect drug companies, even at the cost of human life.
Behind the scenes at the FDA during the approval process for Prozac, Richard Kapit, the chief medical officer in charge of evaluating Prozac adverse effects, repeatedly warned that the drug might worsen depression in some patients. Chapter 3 described his concerns that “Prozac causes a set of adverse effects which resemble those caused by amphetamine,” including agitation, insomnia, anorexia, and weight loss. In his lengthy “Safety Review” in March 1986, dr. Kapit issued a serious warning: “Since depressed patients frequently suffer from insomnia, nervousness, anorexia, and weight loss, it is possible that fluoxitine [Prozac] treatment might, at least temporarily, make their illness worse.” In his summary and conclusion, he re-emphasized that “Depressed patients are often nervous, anxious, and sleepless, and they often experience[d] loss of appetite and weight. It is possible, therefore, that fluoxitine may exacerbate certain depressive symptoms and signs.” He added, “These problems should be examined in future studies of fluoxitine” and concluded his review with the suggestion that the label for the drug “advise physicians” about the danger of an “exacerbation” of depressive symptoms caused by Prozac.
The FDA systematically ignored these and many other warnings that Prozac could worsen depression. It did not require the company to mention any of these dangers in its label. Instead, as we shall see in this chapter, the FDA helped to expunge from the label the only indication of Prozac’s tendency to worsen depression and the company in turn hid critical data from the FDA. Although the FDA did ask the company to conduct post-approval trials specifically aimed at evaluating the danger of Prozac induced suicide, the company simply ignored the FDA, and nothing more was said about it by the government agency. From then on, Eli Lilly and Co. would act as if there were no basis whatsoever to be worried about Prozac worsening anyone’s depression.
British, German, and French regulatory agencies were more responsible in dealing with their concerns about Prozac-induced stimulation leading to suicide. The German and French agencies required some recognition of the problem in the official labels for the drug. In Great Britain, an editorial in the world’s most prestigious medical Journal, Lancet, warned that SSRIs were associated with “the promotion of suicidal thoughts and behavior,” and more recently the British regulatory agency put a suicide warning on the label for Prozac.
In the United States, the FDA approved Prozac without requiring any warning from the drug company about stimulation and suicide. However, after Prozac was approved, hundreds of reports eventually led the FDA to require the company to mention the existence of “suicide” in association with taking Prozac without confirming that it was a proven adverse reaction.
The Anti-Depressant Fact Book: What Your Doctor Won’t Tell You About Prozac, Zoloft, Paxil, Celexa, and Luvox. Known as “the Ralph Nader of psychiatry,” Dr. Peter Breggin has been the medical expert in countless court cases involving the use or misuse of psychoactive medications. This unusual position has given him unprecedented access to private pharmaceutical research and correspondence files, information from which informs this straight-talking guide to the most prescribed and controversial category of American drugs: antidepressants. From how these drugs work in the brain to how they treat (or don’t treat) depression and obsessive-compulsive, panic, and other disorders; from the documented side and withdrawal effects to what every parent needs to know about antidepressants and teenagers, The Anti-Depressant Fact Book is up-to-the minute and easy-to-access. Hard-hitting and enlightening, every current, former, and prospective antidepressant-user will want to read this book.
With a background that Time magazine describes as “pure establishment”-Harvard College, Case Western Reserve Medical School, and a teaching fellowship at Harvard Medical School- Peter R. Breggin, M.D., has become an internationally known psychiatrist and author of a dozen books. The International Director of the Center for the Study of Psychiatry and Psychology, Dr. Breggin lives in Bethesda, Maryland.