A Dark Side to Prozac?

New Study Concludes Drugs Like Prozac May Induce Suicidal Behavior

By Rebecca Raphael

June 21 — In the winter of her freshman year at Harvard, Julie, who requested anonymity, was prescribed Prozac to treat depression. Almost immediately after taking the drug, Julie says she began having trouble sleeping, and within a week, she says she felt agitated and detached.

   “I couldn’t stand how I felt,” she says. “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 this … I couldn’t think about my family; I couldn’t think about my friends. All I could think was, I have to get out of this feeling.”
     About a month after she started taking Prozac, Julie overdosed on over-the-counter sleeping pills. When she was admitted to the psychiatric ward of McLean Hospital in Massachusetts, her doctors noted that she'd had a “paradoxical reaction to Prozac.”
     Julie has a differing — and more blunt — appraisal: She says the drug was the cause of her suicidal feelings.
     “I knew that the suicidal feelings had not been there before I started Prozac. I remember that very distinctly,” says Julie.
     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 an extreme form of agitation called akathisia. 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).
     “SSRI-type antidepressants like Prozac and Zoloft can make people suicidal,” he says.

A Causal Link to Suicide?
In his most recent study, Healy put 20 healthy, non-depressed volunteers on Zoloft, an antidepressant that is believed to work, like Prozac, by boosting serotonin levels in the brain. Two of the volunteers became suicidal.
     “The conclusions are that these drugs can directly cause people to commit suicide,” he adds.
     It is estimated that one out of eight Americans has taken at least one of these SSRIs, so the suggestion of a connection between these drugs and suicide is raising controversy among doctors, patients and manufacturers involved in the $6-billion-a-year market.
     “The data that we’ve reported is quite overwhelming that this drug is not associated with an increase in suicidality,” says Dr. Steven Paul, vice president of clinical investigations at Eli Lilly, the maker of Prozac. “The over 10,000 patients who 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.”
     Pfizer, the maker of Zoloft, says there is “a vast body of valid medical and scientific research” refuting Healy’s theory. Pfizer claims that there was no reliable evidence that Healy’s subjects 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 also presents numerous anecdotes about patients who experienced dramatic changes, including anxiety, agitation, insomnia, suicide attempts and violence toward others after taking SSRIs.
     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.
     “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 says.
     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 transcripts from the same FDA hearing show that three of nine panel members expressed concerns about the data.
     Despite what he believes to be potentially harrowing 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.”
     Healy, too, agrees that these drugs can be highly beneficial, which is why he continues to prescribe SSRIs, including Prozac and Zoloft, though always with careful monitoring.
     What patients need, says Glenmullen, is to be aware of the potential risks and to be monitored closely while on the drug. He 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 her release from the hospital, Julie withdrew from Harvard. She 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.
     Julie believes her ordeal could have been avoided if the doctors treating her had been aware of the possible link between the medication and suicidal thoughts. In her case, one psychiatrist had taken her off the medication, suspecting that Prozac was the cause of her suicidal feelings, only for another doctor to reject that theory and put her right back on the drug.
     She would like to see manufacturers include information about such side effects and 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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