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With any medication, standard marketed drugs or investigational drugs, there is always some risk of adverse side effects. For this reason, patients entered into psychotropic research trials are required to be in excellent health and in a certain age range. (Females of child-bearing age may/may not participate.) Numerous safety evaluations are completed and the results are reviewed by a highly qualified medical team prior to dispensing the medication. Physical examinations, electrocardiograms, blood work, and a detailed medical and psychiatric history are all required along with the patient’s signed consent In addition, each patient’s progress is monitored very closely by the research team, the pharmaceutical company’s clinical team, the investigational review board (IRB) and the FDA.

Possible side effects are explained in advance and patients are able to report these problems any time, night or day. If these side effects pose a risk to die patient, or are too bothersome, discontinuation of medication would be immediately recommended. If during the study, investigators see unexpected adverse effects in their patients, this information is immediately reported to the drug company, which in turn may stop the drug and inform the FDA, if indicated.

All in all the high degree of monitoring means that the risk is minimal. Once in a while, however, problems do occur.

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Yes. But the many people who have heard remarkable stories about Prozac’s effects on mood, personality, and behavior have requested Prozac—and not just from their psychiatrists. They have asked their general physicians, their surgeons, even their dermatologists and dentists to give them Prozac, and many times these doctors have wrongly complied, giving it to patients for whom it is not justified. Nevertheless, even while Prozac is incorrectly and even overprescribed for some people, it is a documented fact that 50% of all depressed people go totally undiagnosed

and untreated. This figure amounts to millions. Many of these could benefit from Prozac and other antidepressant drugs.

Patients who do not suffer from one of the depressive disorder spectrum diagnoses (these include major depression, dysthymia, and subclinical depression as well as many of the personality disorders with at least one or two of the required symptoms of major depression—the so-called formes fruste type) or obsessive-compulsive disorder, should be treated with Prozac only with great caution, because scientific evidence has not been sufficient to gain FDA approval. If Prozac is being prescribed for any illness other than major depression and OCD, it should be considered experimental by the patient and physician, and the patient should be so informed. Caution should be observed.

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They make a tremendous difference. Correctly prescribed and taken, antidepressants generate major improvement in 65% to 80% of depressed patients. Along with lithium and antianxiety medications, the new antidepressants have successfully treated millions of patients worldwide and enabled them to function normally or at least better. No longer need lives be wasted in devastating depression or in destructive uncontrolled manic episodes.

Moreover, these medications have an effect mat extends beyond the lives of those for whom they are prescribed. Depression is not only a personal and family/societal problem, it is also a problem that results in lost time on the job, divorce, hospitalization, suicide, secondary alcoholism, and drug addiction. Depression and other mood disorders waste lives— and money. According to a recent study, the annual costs of depression in the United States total approximately $43.7 billion.

As William Styron remarks in Darkness Visible, depression is a “true wimp of a word for such a major illness”. Depressed people visit their doctors three times as often as do patients without a psychiatric disorder and they spend more days in bed man do people with hypertension, diabetes, arthritis, and back pain.

Yet, with a frequency that is shocking—50% to 60% of the time in primary care settings, 60% of the tune in HMOs—the disorder goes undiagnosed. This is tragic, because when depression is recognized and appropriately treated with medication and/or therapy, § it can be eliminated most of the time—or at controlled.

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Can Prozac be used for chronic fatigue syndrome? Chronic fatigue syndrome is an elusive disease, difficult to diagnose (in part because some doctors don’t believe it exists) and difficult to treat or certainly to cure. Its primary symptom, overwhelming tiredness, often accompanied by disturbed sleep, can also be an indication of depression. Antidepressants, which boost energy, counteract depression, and may help to straighten out the sleep cycle, are frequently useful, and several studies have found Prozac to be successful in treating CFS.

Is Prozac helpful in premenstrual syndrome? Reports indicate that Prozac has dramatically alleviated some premenstrual symptoms in a small group of patients. Some of the symptoms of PMS include irritability, weeping, a depressed or changeable mood swinging from high to low within hours or days, and the feeling of wanting to isolate oneself from others and not participate in outside activities. Given Prozac’s highly successful results with dysthymia and depression, it does not seem surprising that premenstrual depression has been reported to be helped considerably by Prozac. However, further studies are needed.

Is Prozac helpful in the commonly manifested depressed mood seen in Parkinson’s disease?

To date, the evidence is not encouraging. There have been reports of increased motor disability in four patients with Parkinson’s disease who have been exposed to Prozac.

Is Prozac helpful in the commonly seen depressed mood associated with Alzheimer’s disease?

Although in a limited number of cases Prozac does not seem to affect the depressed mood of Alzheimer’s patients, the older antidepressants have been used extensively with some positive results.

What is the effect of Prozac on feelings of depersonalization? Depersonalization is characterized by loss of identity and feelings of unreality and strangeness about one’s own body and behavior. A single study showed that of eight patients treated with Prozac for feelings of depersonalization and obsessive compulsive disorder, six responded positively. A second study found that an elderly seventy-three-year-old man had a marked improvement in his depersonalization symptoms and the associated anxiety after he received Prozac. Only one case reported a thirty-two-year-old bipolar female with an acute depression who actually developed feelings of depersonalization after three days of Prozac (20 mg) treatment These symptoms disappeared after discontinuation of the drug. Clearly further research is needed to give more definite answers to the use of Prozac in treating feelings of depersonalization.

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Patients taking Prozac outside the United States should have a signed note from their American physician explaining what the medication is and what it Is being used for, as required by customs. Prozac is available in many countries under foreign trade names. If the term “Prozac” is not used in a given country, the generic name fluoxetine should be used instead.

If the patient talks to a pharmacy or physician ahead of time, a courier package of Prozac can be delivered within twenty-four to seventy-two hours to most major cities of the world.

There is no need to be unduly concerned about hot weather, mild dehydration, or skipping an occasional meal (as one should be with lithium), none of which should cause any unusual symptoms with Prozac. However, normal food, fluid, and salt intake are required and should be maintained.

What percentage of patients take Prozac for disorders other than depression? Approximately a third. This percentage is gaining steadily with the recent publicity about Prozac’s effectiveness in treating patients with nondepressive disorders, including obsessive-compulsive disorder, bulimia, and personality disorders.

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