The title of this book tells you where Dr. Joseph Glenmullen, a staff psychiatrist at Harvard University Health Services, is coming from. Glenmullen contends that the easy-fix mentality of patients and cost-conscious health plans has driven many Americans into long-term use of antidepressants such as Prozac, which he rightly warns may not be as benign as they're led to believe.
The problem is, some of the associations the author makes between the drugs and major side effects are not widely supported by medical literature. It's true there hasn't been systematic monitoring of long-term effects of the top-selling "serotonin boosters" like Prozac, Paxil and Zoloft, responsible for more than $4 billion in annual sales. Indeed, there have been cases in which the drugs have been blamed for suicides and violence, some leading to legal actions. (And many patients complain of sexual side effects.) It's also true there is no long-term track record to examine because the drugs remain relatively new: Prozac hit the market in the late 1980s; most of the others have been around for less time.
But Glenmullen's alarm about facial tics, agitation, muscle spasm and Parkinsonism is more inflammatory than the available science suggests.
He says such effects "appear to represent Prozac backlash, the brain's reaction to intruding chemicals," yet he makes that association far more by anecdote than hard science. He bases his warnings on his patients, who have taken the medications and on others who were the subjects of case studies. Furthermore, his association of brain cell death with these drugs uses such inflammatory terms as "chemical lobotomy."
Among his more valid criticisms is that prescriptions for the Prozac family of drugs, which target serotonin (a brain-signaling chemical that affects mood, libido, hunger, pain and memory), are written too often for the "worried well." The primary-care doctors who most often prescribe these drugs frequently provide a year's refills without monitoring the patients or trying lower doses, Glenmullen says. He believes that the drugs should be limited to patients with moderate to severe mental illness for whom they can be "invaluable, even life-saving."
He advocates that people with less severe problems try alternatives, about which he devotes half of his book.
Glenmullen is an unabashed advocate of treating milder disorders with therapy--cognitive therapy, family therapy and psychotherapy, which are more expensive from the health insurer's point of view than pills. He's also a supporter of trying herbal remedies like St. John's wort, 12-step programs, and lifestyle changes such as regular sleep and aerobic exercise. He says these may help with some of the disorders for which Prozac and its sister drugs are prescribed, like mild anxiety and mild depression.
Like author Elizabeth Wurtzel, who in her bestseller "Prozac Nation" questioned whether a drug that made her feel so much better might be "hurting me at another end," Glenmullen raises important questions about the use of these drugs. But readers should be careful to note that despite all the scientific citations at the back of the book, many of the most serious consequences of taking the drugs still fall into the category of "possible," not "proven."