Prozac Is Medicine, Not a Miracle : Depression: Media stories are distorting this drug’s value; it’s not a ‘cosmetic’ ‘self-indulgence’ to correct a brain dysfunction.
One of my psychotherapy patients, a very bright 41-year-old woman who used to suffer from suicidal depressions and is now taking steps to acquire the Ph.D. she always wanted, recently came into my office visibly annoyed. “Have you seen Newsweek?” she asked. “They’re saying that the antidepressant I’m taking has turned me into somebody I’m really not. What are they talking about? I feel more like myself than ever!” She isn’t the only person I know who is appalled by this latest outburst in the media’s love/hate relationship with Prozac.
I have prescribed this medication for hundreds of patients in the past six years, and I don’t know of one who has experienced the kind of miraculous personality change that is being discussed so much on talk shows and in the popular press. Quite the contrary: Appropriately selected recipients of the SSRIs (selective serotonin re-uptake inhibitors) and other new antidepressants find that their longstanding symptoms give way to what most of them would call simply “feeling normal.” Is it any surprise that this improved sense of well-being creates sometimes dramatic increases in self-confidence, assertiveness and initiative?
If you can’t actually change your personality with a pill, where did this fantastic notion come from?
It’s right there in psychiatrist Peter Kramer’s introduction to his best-seller, “Listening to Prozac”: “I wrote about patients who became ‘better than well,’ patients who acquired extra energy and became socially attractive. My mnemonic for this effect was ‘cosmetic psychopharmacology.’ That two-word phrase, as it happened, did for me what Prozac had done for certain of my patients: It made me instantly popular.”
While Kramer merits some praise for his diligent scholarship and articulate writing, the glib and inaccurate catchword that brought him into the limelight has threatened to undermine the credibility of psychopharmacological therapy, frighten away patients in need of treatment, demean current users and seduce the wrong people into seeking prescriptions. The problem is that he characterized as “cosmetic” rather than therapeutic the corrective effects of Prozac on the more subtle chemical imbalances that fall outside accepted definitions of psychiatric disease.
Although we don’t have familiar names like “depression” and “panic disorder” for manifestations of serotonin depletion such as irrational anger, hypersensitivity to rejection, chronic pessimism, obsessive worry and fear of risk-taking, the personal and social consequences of these symptoms can be extreme. How many individuals who resort to alcohol and illegal drugs have been trying unsuccessfully to medicate their own chemical imbalances? How many murders and suicides have resulted from such disturbed states?
Partly hereditary and partly acquired through severe or inescapable environmental pressures, these well-documented disorders can cause otherwise high-functioning people to experience painful problems in their relationships, their work and their inner lives. No amount of psychoanalysis, psychotherapy or homeopathy can budge the manifestations of chemical imbalance.
As with any physical disorder, underlying causes must be addressed first before any other treatment can be effective. Patients have the right to expect all health-care providers to become adept at recognizing these conditions and, if unable to render skilled treatment, to make appropriate referrals. Since any medicine can create problems if used improperly, careful and ongoing professional attention to symptoms, side-effects and dosages is essential. Furthermore, the self-defeating patterns that typically form while people are chemically depleted will often continue to place an undue burden on their neurotransmitter systems unless they somehow learn how to manage their lives more effectively. Research shows that the combination of medication and psychotherapy works better than either method alone.
Sadly, there are still many professionals and self-help organizations that do not recognize the difference between SSRIs and addictive drugs. The fact is that, unlike addictive drugs, these medications have no effect on people who do not suffer from the chemical imbalances they treat. Although Kramer’s description of the “better than well” patient might conjure up the image of a drug-induced “super-self,” what he was actually observing was just the natural human response to having a longstanding biochemical burden lifted for the first time. There is nothing “cosmetic” about having a brain that works the way it should. If we would just set aside the American fixation on self-lifting bootstraps, we would recognize that the people who benefit from these medications aren’t spoiled, self-indulgent individuals trying to escape the responsibility of being themselves. Nor are they frivolous thrill-seekers looking for a new kind of “high.” They are human beings who know quite clearly that there is something wrong with the way they feel.
I genuinely hope that Kramer’s trivializing and the misleading publicity that it has spawned won’t dissuade too many people with these often treatable conditions from seeking or accepting help. Unfortunately, headlines and sound bites about “personality pills” and “legal drug cultures” seem to find their way into the media much more readily than do accurate and well-moderated representations of medical and scientific breakthroughs.
