Medical Tuesday Blog
Elizabeth Wurtzel |Prozac Nation | 1967 – 2020 Happy anniversary | By Jessica Apple | Published: November 17 2007 | Financial Times
On the occasion of the author of Prozac Nation death this month, we recall the two full page article in The Financial Times in 2007 on the 20th anniversary of Prozac. Jessica Apple gives a very personal rendition of her experience with depression and her tribute to the miraculous treatment with Prozac. What some saw as a short-term treatment for depression has become a way of life. When it first became available, there was a stigma associated with its use. Now I see generics of Prozac on the medication list of patients, as well as friends and relatives.
When it first became available in the US, no one could have anticipated how radically Prozac would change the way we treat depression and anxiety disorders. Fluoxetine, the scientific name for Prozac, wasn’t even originally designed as an antidepressant. Eli Lilly, the company which makes Prozac, first tested it, unsuccessfully, as a drug for high blood pressure, and then, again unsuccessfully, as an anti-obesity agent. But when Fluoxetine was finally approved by the US Food and Drug Administration in 1987, as the antidepressant Prozac, its effect was immediate. Mildly depressed patients were often not good candidates for the tricyclic antidepressants used since the 1950s, or didn’t want to risk the potentially severe side-effects of monoamine oxidase inhibitors. Suddenly they had real hope of relief.
Now about 54 million people around the world take Prozac, and many more millions take its sister selective serotonin reuptake inhibitor (SSRI) drugs. With so many people treating their depression this way, the most surprising fact of all may be that anyone could still be ashamed of doing so. And yet not a single SSRI user I contacted for this article wanted his or her name in print. . .
Nearly a decade ago, on my honeymoon in Venice, I realised something was terribly wrong. I had no doubts that I loved my husband, but I didn’t feel anything close to romantic. Instead of seeing the beauty of St Mark’s Square, I thought about the public executions that once took place there. I got dizzy from looking up at the ceiling mosaic of the Basilica. The crowds of people made me nervous, and the gondolas struck me as nothing but charmless tourist traps. I didn’t even have an appetite for pasta.
On our third day in Venice, my husband and I took a water bus to Murano, the Venetian glass-making island. I leaned against the railing of the water bus and felt the strong wind on my body. When I reached up to brush my long, curly hair out of my face, a handful of it came out in my palms. . .The hair wasn’t a total surprise. In the two months preceding my wedding, I had noticed that I was losing more hair than usual. In the mornings. . . I would spend the next hour imagining the different diseases that might be causing me to shed like a cat. But on that boat ride to Murano something more than exaggerated worry was happening. As I held my hands over the railing and let the wind carry my curls away, I had the distinct sense I was tossing my own ashes out to sea.
Back home, my doctor could find no reason, other than stress, for my hair loss. He recommended I see a psychiatrist and start treatment with an antidepressant. It turned out that the one disease I hadn’t diagnosed myself with was the one I had – depression.
The psychiatrist didn’t hesitate to give me Prozac, and the change in me was both subtle and dramatic. After a few weeks on 20mg of Prozac, I had energy, not just physical energy, but energy in my soul. Other than the sense of vigour, my body did not feel noticeably different. But what was dramatic was that not only did I stop thinking about death, I began to sing. I sang to my dog and cats. I sang while I washed dishes. A few times, I even sang in the shower. I also noticed that I didn’t feel panicky when people looked at me. I didn’t even mind it. What happened to me was exactly as Elizabeth Wurtzel described in her bestselling memoir, Prozac Nation. Wurtzel says that after she began to take Prozac, ”something just kind of changed in me* I became all right, safe in my own skin. It happened just like that.” Just like that, after months of having to force myself to eat, my appetite returned.
Then something else happened. As I was beginning to take pleasure in my daily life for the first time in nearly a year, I wanted to stop taking my pills. Prozac had freed me from depression and from a list of anxieties that included everything from killer bees to rare diseases to radioactive waste, and all I could think of was how quickly I could get rid of it.
The dilemma I found myself struggling with is not unique to me. Although there are no surveys which pinpoint this particular phenomenon, conversations with experts and numerous Prozac users around the world revealed the paradox again and again: former depressives, feeling much better in general, believe they ought to stop taking the very pills they need to live a happy life. We may indeed be a Prozac Nation, but one thing remains clear: we’ve yet to come to terms with our diagnosis. . .
Depression is a subjective experience. There is no reliable way for doctors and scientists to measure it, and experts still can’t agree what causes it. As an SSRI, Prozac is in a class of drugs that includes Paxil and Zoloft among others. Low levels of serotonin can lead not only to depression, but also to a range of anxiety disorders, from panic and obsessive-compulsive episodes to social anxiety.
On a molecular level, we broadly understand how SSRIs work. Serotonin is a neurotransmitter – a chemical that relays signals between neurons and other cells – that affects mood. When serotonin is relayed from one cell to another, the cell sending the serotonin will typically reabsorb whatever is not successfully transferred. SSRIs prevent this reabsorption, thus allowing more serotonin to reach the receiving cell. This, at least, is the commonly held theory of how SSRI’s improve mood. Perhaps revealing just how little we understand depression, even after 20 years of research alternative explanations are still being put forward. In one intriguing development, Ronald Duman, a researcher in the department of psychiatry at Yale University School of Medicine, has demonstrated that SSRIs can lead to the growth of new brain cells. Duman’s research on rats suggests neurogenesis in the hippocampus, a part of the forebrain, contributes to the anti-depressive effect. . .
I made the decision to stop on my own, without consulting any doctors. At the time, I was a graduate student in ancient near-eastern studies. I was reading The Epic of Gilgamesh, which tells a story about people living in Mesopotamia in the third and second millennia BCE. In the tale, Gilgamesh, who is part-God and part-man, is forced to reconcile with his mortality. Through the death of his best friend, and his own futile quest for immortality, Gilgamesh learns that without death, life would be meaningless. I asked myself if I was using Prozac to numb myself to the meaning of mortality. Or was there something larger at play, something closer to pathology than to literary wisdom? . . .
”We know now from some long-term studies that of people who have been on SSRIs and other antidepressants, about half of them will relapse in a period of two to three years,” says Richard A. Friedman, professor of clinical psychiatry and director of the psychopharmacology clinic at Cornell’s medical school in New York City. . .
I’ve tried many alternatives to Prozac: psychotherapy, behavioural therapy, hypnosis, yoga, meditation, various diets, flower essences and exercise to obliterate the sense of dread that often overwhelms me. None of these things has come even close to being as effective as Prozac. It has taken me almost a decade of on-and-off misery and on-and-off Prozac use finally to solve the Prozac paradox, to come to terms with the pill, not as a demon or a panacea, but as a simple drug that alleviates my psychic pain.
And with this realisation comes the larger realisation that Prozac makes me a happier, calmer person by increasing the uptake of serotonin in my brain, and swallowing the pill does not signify something is fundamentally wrong with me. . .
Ultimately, I have to pull myself through the day, and if Prozac is the hand that can help me, and if I need it, as millions do, I should grab on without being ashamed of myself. ”Antidepressants help those who help themselves,” Andrew Solomon says. ”To take medications as part of the battle is to battle fiercely, and to refuse them is as ludicrous as entering a modern war on horseback.” . . .
All cultures have accumulated and dispensed advice about overcoming depression, and Robert Burton in the early 17th-century concluded his book, The Anatomy of Melancholy, with this simple cure: ”be not solitary, be not idle.” It was great advice in Hamlet’s time and it still is. But it’s even better if you take it with 40mg of Prozac.
Jessica Apple is a writer living in Tel Aviv. She’s working on a memoir, ”Still Life”, and a story collection, ”Artificial Selection”.
Copyright |The Financial Times Limited | 2007
Also see the WSJ article on Wed Jan 8, 2020
Prozac Nation is a memoir by Elizabeth Wurtzel published in 1994. The book describes the author’s experiences with atypical depression, her own character failings and how she managed to live through particularly difficult periods while completing college and working as a writer. Prozac is a trade name for the antidepressant fluoxetine.
Wurtzel originally titled the book I Hate Myself and I Want To Die but her editor convinced her otherwise. It ultimately carried the subtitle Young and Depressed in America: A Memoir.
Whom Should We Remember?
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