August 2, 2001

11:22 PM

Why is everybody so happy?
This Thursday, U.S. regulators approved numerous copycat versions of Prozac. I wonder how long it will be until Bayer makes Flinstones Chewable Prozac for teens.
posted by lheiskell (34 comments total)

This wholesale doping of people pisses me off.
Prozac works a whole lot like cocaine, only with a different nureotransmitter mix being pooled in the brain.
When taken for depression, you're treating an imbalance with an imbalance.
Years from now, I predict this period of our medical history will seem particularly primitive.

Besides, I can take all the prozac type pills I want, and I'd still look like AJ from the Backstreet Boys. What's the bloody point?
posted by dong_resin at 11:58 PM on August 2, 2001

Um, there are some important differences. I'm not addicted to Prozac, y'see...
posted by whatnotever at 1:57 AM on August 3, 2001

SSRIs are a godsend. It supremely pisses me off when some mentally balanced armchair psychiatrist starts spouting off the merits of life without SSRIs for those who have gotten their lives back from debilitating mental disorders.

There is nothing physically addictive about the family of SSRI drugs. In fact, if anything seems at all primitive, it is the widespread belief that adults who take these drugs cannot see the difference themseves, between addictive narcotics and medications which truly give them their lives back.

There is one thing I am addicted to though. . .

Never ever wanting to go back to life without a virtually side effect free treatment. Six years of regular Luvox treatment has allowed me to be here today on Mefi, being accused incessantly of hyperbole and non-concise argument. I wouldn't have it any other way. It's about being fucking alive!
posted by crasspastor at 2:22 AM on August 3, 2001

Besides dong, I thought you liked the idea of 2001 having finally arrived? ;-)
posted by crasspastor at 2:27 AM on August 3, 2001

I think a lot of the opposition to SSRIs by those who don't take them is because people tend to be pretty afraid of having something mess with their minds -- brainwashing and cult programming and so on -- and fail to understand that some minds really need messing with.
posted by fidelity at 3:22 AM on August 3, 2001

These are just generics of fluoxetine, which is slightly depressing (ahem) given that Prozac is the sledgehammer-nutcracker of SSRIs. At least it breaks Eli Lilly's monopoly on the damn drug, but that probably means it'll get prescribed to those who might be better off with a targetted norepinephrine reuptake inhibitor such as reboxetine or venlafaxine (Effexor).
posted by holgate at 4:04 AM on August 3, 2001

I did take an SSRI, (welbutrin) just long enough to cultivate my hate for it. If it works for you, great. Everybody is wired differently.
I felt violently horrible, however, and after reading about how it actually works, quite angry with the way I was glided right on through the shrink's office into the wonderful world of drugs. It is absolutely addictive for many people, as well as offing an increasingly nasty array of side effects for those who build up a tolerance to it.
posted by dong_resin at 4:36 AM on August 3, 2001

Damnit, browser crash...

My girlfriend, who's training to be a therapist, says that HMOs regard therapy as something of an indulgence, and only fund a limited number of sessions: so you get fast-food psychology, attempting to do in six weeks what you'd normally stretch over a few months. (The paradox being that it's accepted that SSRIs take 4-6 weeks to kick in.)

Of course, therapists tend not to have the luxury of large marketing departments to produce soft-focus advertising or tchochkes and samples for physicians: opening the market for fluoxetine producers, with the inevitable price war, isn't going to offset that imbalance.

(for the record: Prozac, which brought agoraphobic panic attacks; Seroxat, which made me simultaneously motivated and uninspired; Zoloft, which was about right, but isn't available in the UK.)
posted by holgate at 5:25 AM on August 3, 2001

I'm for one pleased that Eli-Lily finally got the boot on their patent. Manufacturers still have loopholes in patent law that allow their patents to be extended, keeping prices high and stopping competition from generic brands. Anybody know if the McCain bill to close said loophole passed?

I think the goal, when possible, is to use treatment that allows a person to be fully self-sufficient. If that can be accomplished without using SSRIs or other drugs, through therapy, then I think that's a good thing. But if therapy just isn't working, then the drugs make sense. People think (as many HMOs do, like holgate said) that mental health isn't as serious or as important as physical health. Many times, however, it's just the opposite. If your mental state is affected, your body isn't going to be doing too well, either.
posted by gramcracker at 5:54 AM on August 3, 2001

It's cheaper to medicate the symptoms than to correct the problem. Shame.
posted by NJguy at 6:35 AM on August 3, 2001

Where can I get my hands on some Gleemonex?
posted by Dirjy at 7:49 AM on August 3, 2001

am I the only one who found the tone of the Reuters article disturbing? Eli Lilly was named specifically a little more often than I thought was necessary ("yes, thank you, I know the glorious saviours of the depressed were Eli Lilly and Company, like you said two paragraphs ago...") and a variety of negatively-connotated words ("copycat", "knockoff") were used almost exclusively to describe the generics.

Anyone know of corporate incest between Lilly and Reuters, or was the editor on this just a Lilly stockholder?
posted by Vetinari at 8:05 AM on August 3, 2001

This wholesale doping of people pisses me off.


I can't believe the ignorance of this statement. Should we just tell the chronically depressed to cheer up. Drugs are tools, its how they are used that matters.

I've been on SSRI's and noticed no "doping" effect, but every drug effects everyone differently. Prozac is often discarded for Paxil because of Prozac's side effects. Not to mention non SSRI anti-depressants like Wellbutrin, Serzone, etc.

If history is going to look back on this expect more of a focus on social/genetic factors contributing to a malaise, severe in some and the tools to treat it. Everything is "primitive" from a futurist perspective, dong.
posted by skallas at 8:10 AM on August 3, 2001

Everything is "primitive" from a futurist perspective, dong.

Well, medicine is historically more primitive than its contemporary research-orientated biological sciences, simply because you have to deal with what you could call the "legacy systems" of existing treatment regimes. That's why 18th-century neurological cures resemble 17th-century exorcisms: you're giving people what you think works, in a form they expect to work.

And even now, most neuroscientists regard the emphasis on serotonin as "sledgehammer" pharmacology, preferring to concentrate their own research on norepinephrine and the other neurotransmitters. But this thread talks about it in greater detail.

But you're right, it's definitely a social/cultural phenomenon, like Laing and schizophrenia in the 50s and 60s.
posted by holgate at 8:25 AM on August 3, 2001

Paxil is evil. Ten percent of people who take it become suicidal. The doctors put me on that crap, didn't help one bit. I don't need drugs! But typing with my nose sure is hard, damn straight jacket.
posted by Apoch at 8:31 AM on August 3, 2001

I'm somewhere inbetween the land of Medicate Everything! and Medicate Nothing! There are people who definitely benefit from anti-depressants (and I have several close friends who do). I'd also say that there are a lot of doctors who overprescribe them in order to gloss over the problem.

For example, I used to live in Utah (please don't ask me why) and Utah has the highest use of Prozac and other anti-depressants than any other state (see here). Now, I could be wrong, but I don't think it's because they have the highest percentage of people who chemically NEED it. I think it has a lot to do with the religion and culture there and women getting married at 19, having children at 20 and then realizing at 30 that they are completely unhappy because they never had their own life but their religion tells them that they SHOULD be happy. But that's beside the point and I'm probably bringing my own cynical judgement into the equation ;-).

I just feel like there should be more of an effort made BY DOCTORS to ensure that the medication is necessary. Most people don't want to be taking anti-depressants, so I don't think it's a rush on the product by consumers. I feel the same way about Ritalin, except I think it's often the parents who are pushing it in order to "calm their children down." Why don't they just use "Kid Valium" like on SNL? Now I'm getting off topic so I'll stop.
posted by witchstone at 8:52 AM on August 3, 2001

But is it the doctors? I recently received word through my therapist from my HMO that they would not continue to cover my monthly visits unless I was medicated. I've finally come out of a long (years) struggle with dysthymia and I don't need medication. My HMO is quite happy to pay for what I think would be more expensive crisis managment, but they won't cover preventative care in the form a monthly visit to my therapist. Between the taboos around mental health and the steam roller approach of the HMOs, who knows if the patients are getting what they really need.
posted by heather at 9:20 AM on August 3, 2001

After trying meditation, psychotherapy, exercise, drinking, not drinking, healthy diets, positive thinking, self help books -- basically anything I could think of -- Zoloft was the only thing that got me out of a life long depression. It is far and away the best thing that ever happened to me. SSRIs are truly a godsend.
posted by drunkkeith at 9:29 AM on August 3, 2001

hmos are pushing ssris and other drugs on people who would do just as well with (more expensive) alternative therapies. I don't think it's right to say that no one needs the drugs, or that they're never useful, but they are almost certainly overprescribed. doctors (pressured by hmos, no doubt) and patients (many of whom just want a quick fix) treat them like tylenol, even though they're chemicals that change the way your brain operates and have the potential, with long-term use, to permanently alter the structure of your brain.

and yes, I've been depressed/manic/suicidal so please don't jump to any conclusions about what I know or don't know. it was very alarming to discover how easy it would be for me to get a prozac prescription based on a single conversation with a doctor who barely knew me (I didn't take it).
posted by rabi at 10:09 AM on August 3, 2001

SSRIs do indeed work wonders for some people, but I also think they are also overprescribed due to the fact that handing out a prescription is much cheaper than going the therapy route (perhaps in conjunction with medication).

The problem is not the drugs, but a health care system that is increasingly for-profit and thus motivated by making a buck rather than helping the patient. In a for-profit health system, those few with the most ability to pay will have the benefit of the latest, greatest, and most sofisticated medical care available. (Whether they need it or not.) The poor will have no care, or the care they have will be substandard and revolve around crisis-management rather than health maintenance and disease prevention. The rest in the middle will receive the absolute minimun care necessary since the treatments they will have financial access to will carry slim or negative profit-margins for the delivery institutions.

Until we take the profit motive out of health care, short cuts and quick fixes will continue to be the first line of intervention.

Some things capitalism does well. Some things it doesn't.

The rich stay healthy and the sick stay poor.
-US
posted by edlark at 10:35 AM on August 3, 2001

er... U2
posted by edlark at 10:39 AM on August 3, 2001

some minds really need messing with.

Boy, do they! ;)
posted by rushmc at 10:58 AM on August 3, 2001

Some things capitalism does well. Some things it doesn't.

You'll still see overprescription in contexts where the profit motive doesn't apply so much, and the emphasis is simply on getting everyone through the doctor's surgery. From personal experience, college doctors are very quick to sign off Prozac prescriptions, even when there's a decent counselling service funded by the university, because the work pressure on students demands a quick fix. And before Prozac became widely prescribed on the NHS, the anti-depressant of choice was (scarily) temazepan, which turned friends into zombies.
posted by holgate at 11:05 AM on August 3, 2001

By the way, to set the record straight-Wellbutrin is not an SSRI. It is a different class of med altogether. I should know. I take both Wellbutrin and Zoloft.
I might add, prescribed by an EXPERT and not a G.P........it scares me how many people just go get a prescription for the drug-of-the-month without realizing the drug needs to be matched to the person. There is a lot of stuff out there-and if someone is an undiagnosed bipolar, then the fun begins....(not.)
posted by bunnyfire at 11:14 AM on August 3, 2001

hmos are pushing ssris and other drugs on people who would do just as well with (more expensive) alternative therapies.

It's bad to choose a less expensive therapy when the more expensive alternative therapy would only do "just as well"?

No, SSRIs don't address the root cause of the depression, and in many cases this needs to be addressed by other therapy. However, the drugs can make life more livable while (e.g.) cognitive therapy progresses. Also, in my experience they can help people help themselves if the depression is largely situational, by making the issues that are causing the depression seem to lurk less. (That's the only way I can describe it. Think of Dirk Gently's fridge in The Long Dark Tea-Time of the Soul.) The issues seem more manageable and you are much more able to address them and make permanent changes to your life, which will last long after the drug treatment ends.

Six months on Paxil resulted in me making numerous changes of my own, which eventually (six months after I went off the drug) led to me getting the hell out of Detroit, which was the best thing I ever did. I am happier now than I've been in my life, and I'm happy even without having the things (e.g. a girlfriend) I thought were prerequisites to my happiness. Sometimes you just need to be relieved of despair, and once it's gone you are enabled to change the things that were holding you down.
posted by kindall at 11:14 AM on August 3, 2001

It's bad to choose a less expensive therapy when the more expensive alternative therapy would only do "just as well"?

that's a hard question since I don't really know who could quantify "just as well" except the patient, but... yes, when the less expensive therapy involves flooding the brain with serotonin so that the brain produces fewer serotonin receptors so that the same dosage of the drug is less effective and the chances of withdrawal and/or relapse are high in the event the patient goes off the drugs cold turkey.

I am all for temporary medication as sort of a kickstart or a supplement to other changes, as you describe kindall. that's where these drugs can be really useful, or even lifesavers. and maybe some people will need them forever. it just doesn't seem prudent to assume that they'll be necessary forever, or to prescribe them without paying attention to any other aspects of the situation and without making long-term considerations.

college doctors are very quick to sign off Prozac prescriptions
bingo. prozac and birth control are like candy at college. some people don't even have to ask for them; go in and say you're a little sad/stressed/tired and the next thing you know you've got a little packet of blue pills. (the great thing is that plenty of big universities get grant money and other funds from the same corporations that make and market these drugs.)
posted by rabi at 11:27 AM on August 3, 2001

rabi, you're alarmed that a consultation with a licensed psychotherapist would allow you to be prescribed a drug? Hell, I'm shocked out of my boots. Whaddaya want, a committee?

There are legitimate objections to Prozac and others in the SSRI family. First is the longstanding fact, known even before the days of 'zac, that people tend to get better at the same rate, whether they have drugs, therapy, or neither (Eysenck's finding). It's frustrating to therapists, even more so to patients, but sometimes a patient will have to participate in several different approaches before one "works" and even then finding a long-term treatment (cure is a misnomer) is possibly itself a challenge. Studies today show that 75% of patients who receive therapy are better off afterward, though this may simply reflect Eysenck's findings (meaning some would have gotten better anyway, and some got better without, offset by those who wouldn't at all).

Second is that there is the slim possibility of the drug giving the suicidal person the energy to commit the deed, and in very rare cases inducing suicidal thoughts in previously unsuicidal patients. No drug should be taken without monitoring.

Prozac and SSRIs are routinely prescribed, however, not because we've suddenly become pill-happy or because HMOs are pushing for shorter therapy. (I don't think it takes an HMO to be skeptical of the Freudian-style life-long psychotherapy that was faddish a generation ago.) They're prescribed because unlike previous antidepressants, they have fewer side-effects (but see the admonition about monitoring and trying other treatments), and most important, it's almost impossible to overdose using an SSRI.

We didn't prescribe cognitive therapies and fluoxetine in the 1970s because we were smarter then. They didn't exist yet. Since then they've been found to be as effective as more expensive, more extensive therapies. (See admonition about overall statistics.) There's nothing remarkable about that timeline.

When you compare SSRIs to its predecessors, such as Valium (the classic "mother's little helper" pill, after alcohol), I think the SSRI wins hands down. Valium does "dope" you, putting you in a depressed, relaxed state. SSRIs may be a drug, but they do not dope you. In fact, most people can't immediately tell that they're on a drug (and almost nobody else can tell, either). Calling what an SSRI does "doping" is, in my point of view, a vicious lie. It does not describe the experience of most patients, and it does not describe the affect that others see. People on SSRIs are more effective at tackling the problems of life, rather than retreating from their problems.

And to address the opposite misunderstanding by the general public: SSRIs are not "happy" pills. If anything, when I was on Prozac, for the first time in a while I could feel the full range of emotions from happy to sad. Before I was walking around like a robot. With the medication, I was mainly able to think more clearly and break through a mental fog.
posted by dhartung at 12:08 PM on August 3, 2001

I was alarmed that I could go into a general practitioner's office, mention that I was emotionally lost and "feeling a little out of control" and immediately be offered a prescription by a doctor who didn't bother to:

1) find out what other medications I was on (there are thirteen)
2) ask whether I had done anything else about it (not much)
3) look at my medical history (I have several chronic, potentially life-threatening illnesses that have resulted in multiple hospitalizations/operations)
4) suggest that I see a therapist
5) ask about the occurrence of mental illness in my family (high)
6) tell me how the medications worked
7) mention any potential side effects
8) find out why I thought I felt that way
.... etc, etc.

do you think that's not alarming? I don't want a committee (although there's nothing wrong with the occasional second, or third, opinion), but I'd like some care to be taken in finding the best possible solution rather than the easiest and fastest.

(in contrast, my doctors had to jump through hoops-on-end before my hmo would let me see a behavioral medicine specialist for biofeedback training, which has helped decrease my dependence on vasodilation drugs.)

When you compare SSRIs to its predecessors, such as Valium (the classic "mother's little helper" pill, after alcohol), I think the SSRI wins hands down.

I agree. thumbs up. that doesn't make it okay to prescribe them willy-nilly any more than it makes it okay to condemn anyone for needing them.
posted by rabi at 12:49 PM on August 3, 2001

In fact, most people can't immediately tell that they're on a drug (and almost nobody else can tell, either).

I agree with a lot of what you say, but I have to disagree with this statement. In my experience, the behavioral changes in a person on one of these medications is VERY apparent to both themselves and to those who know them. Okay, you say "immediately" and there is usually a lag time before the effect really kicks in given the way the chemistry works (which varies depending upon both the drug and the individual), but the fact that the effect is delayed does not, it seems to me, invalidate the fact that they often DO produce a recognizable effect (if they did not, who would take them?).

I think there is a conflict between two definitions of "doping" in this thread. For some, it means "dulling, slowing, making drowsy and unresponsive," while for others it seems to mean simply producing an effect, of any kind.
posted by rushmc at 1:37 PM on August 3, 2001

Is anyone on MeFi *not* taking drugs? I take Tofranil for ADD, but the antidepressant is a nice side effect. I think.
posted by mecran01 at 2:56 PM on August 3, 2001

I don't take anything but nicotine and caffeine.

And Allegra, but that don't count, right?
posted by sonofsamiam at 3:16 PM on August 3, 2001

a better question might be, is anyone in america not taking drugs (who can afford to)? ;)
posted by rabi at 4:22 PM on August 3, 2001

I am not taking drugs other than caffeine and some wine.

Now that there's big time perscription drug advertising, is it only a matter of time before celebrities endorse drugs?
posted by ParisParamus at 4:29 PM on August 3, 2001

It's pretty much already at that point. Mike Piazza, New York Mets all-star catcher, is in some commercials for one of the prescription allergy meds (forget which one).
posted by Mrmuhnrmuh at 5:43 PM on August 3, 2001