Pushing Prozac (cont.)

Should people who feel better on Prozac shred their prescriptions? Not just yet. This debate is far from settled.

Some leading psychiatrists and mental health advocates are outraged at the views of Glenmullen and other critics. "Patients say to me, 'I feel normal for the first time in my life,' " says Harvey Ruben, MD, a clinical professor of psychiatry at the Yale School of Medicine.

Ruben calls much of Glenmullen's book "pure speculation." Yes, the antidepressants cause side effects in some patients -- every drug does. "For any drug, if you look in the Physician's Desk Reference, there are probably 150 side effects, many of them so severe that you'd probably never take the drug if you read them," he says. "Glenmullen has taken legitimate side effects, which are very rare, and some terrible case histories, and written a book that makes the uninitiated reader believe that these side effects happen to everybody."

Several psychiatrists also dispute the studies that question the clinical effectiveness of antidepressants. "If you look at all of the studies in the world literature, there are no studies in which a placebo is better than an antidepressant," says Columbia psychiatrist Frederic Quitkin, MD. "In 60% to 70% of the studies, the antidepressant performs better than a placebo. It's simply impossible for that to happen by accident."

What about the studies that seem to indicate that placebos work just as well as antidepressants? Quitkin believes that some of these results may be attributable to flaws in the way the studies were designed and conducted. If a study isn't long enough, or uses an inappropriate dose, it may show a drug is less effective than it really is.

Some experts even call Glenmullen's book dangerous because it may discourage depressed people from seeking treatment. "The truth about depression is just the opposite of what the book claims," says Mike Faenza, president of the National Mental Health Association, which receives some funding from Eli Lilly and Co. Depression isn't overdiagnosed, it's underdiagnosed and undertreated, he says, and reports of antidepressants' risks are greatly exaggerated.

Years will likely pass before psychiatrists can accurately answer the question: Are Prozac and similar drugs worth it? In the meantime, even vehement professional rivals agree on some basic advice for patients like Carla. Antidepressants are useful to a great number of people, say both Prozac critic Glenmullen and supporter Ruben. The key for both physician and patient is to be cautious and conservative with these or any drugs.

"Don't start people who don't need the drug," Ruben says. "Start at the lowest dosage and monitor usage carefully. In my office, nobody ever gets an automatic refill. If you have to call and check in, we can monitor your usage. Doctors giving nine months of refills -- that's just negligence, and that's why we try to educate people."

Gina Shaw, a Washington-based medical writer, reports regularly for WebMD.

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