Prozac and SSRIs: Twenty-fifth Anniversary

David Healy, MD
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Prozac was approved in 1987 in the US, and launched in early 1988, followed by a clutch of other SSRIs. Twenty-five years later, we now have one prescription for an antidepressant for every single person in the West per year.

Twenty-five years before Prozac, 1 in 10,000 of us per year was admitted for severe depressive disorder – melancholia. Today at any one point in time 1 in 10 of us are supposedly depressed and between 1 in 2 and 1 in 5 of us will be depressed over a lifetime. Around 1 in 10 pregnant women are on an antidepressant.

No one knows how many new cases of depression there are per year partly because modern depression is a creation of the marketing of Prozac. Until recently what is now called depression was called anxiety, nerves or a nervous breakdown. SSRIs can help some cases of nerves but they are of no use for depression proper – melancholia. But the money for companies lies in treating nerves not melancholia – and as a result any of us with severe depression is likely to get worse treatment now than we once did.  We’ve gone backwards.

By 1999 the number of us taking SSRIs chronically equaled the number starting an SSRI each year. By 2003, over 6 million Americans were taking an antidepressant semi-permanently – along with over 6 million Europeans.

The number of prescriptions for antidepressants is increasing by 5-10% each year, while the figure for people starting each year remains the same. This means that there is an increase of 5% to 10% in the number of people hooked to antidepressants each year.

There is no research evidence to suggest that anyone’s life is saved by taking an antidepressant but if there are lives saved the research makes it clear that for every life saved there must be another lost. There are probably something between 1000-1500 extra suicides in the US each year, triggered by an antidepressant – an extra 2000 -2500 in Europe.

The data is similar for violence. There are probably between 1000- 1500 extra episodes of violence in the US each year that would not have happened without antidepressant input and between 2000-2500 extra episodes in Europe.  Some of these will include school or other mass shootings which were unheard of twenty-five years ago.

About 4000 families in the US have children born with major birth defects each year because of antidepressants taken in pregnancy. Up to 20,000 women per year have a miscarriage because of these drugs and a large number have voluntary terminations linked to antidepressants. Miscarriages are among the biggest single predictors of later mental illness and substance misuse in women.  In Europe these figures likely run at an extra 6000+ birth defects, 30,000+ miscarriages, and who knows how many extra voluntary terminations.

Most children born to mothers who have been on these drugs do not have obvious birth defects. But it increasingly looks as though these children may show cognitive delay and other autistic spectrum features.

Perhaps the greatest casualty of Prozac has been holistic medicine. Imagine you have numbness in an arm or pain in a shoulder. If referred to an orthopedic or neurology department you will have every conceivable scan or test to pinpoint the problem. Chances are the clinic will find abnormalities and attempt to put things right – abnormalities that are not the source of your problem. A good generalist, who knows your circumstances, relationships, difficulties at work and the community from which you come, can spot when aches and numbness stem from strain or tension – they see you rather than bits of you.

Prozac has killed Generalism. It did so by focusing attention on mood in the way neurologists hyper-focus on nerves. Psychiatrists have become the doctors who deal in heroic combinations and doses of pills rather than doctors who, like generalists, step back and take a broader view.

Prozac has also killed therapy – just like Prozac CBT has a hyper-focus on thoughts rather than the big picture. CBT has also become a conduit into antidepressant prescribing as therapists regularly suggest softening up a depression with pills.

Many see or saw psychiatry as a medical backwater with grim, overcrowded hospitals, and a dim understanding of the disorders it treats. In fact it was the first branch of medicine to have specialist hospitals and journals, the first to discover the bases for and eliminate several serious disorders, the first to adopt rating scales and controlled trials. And with Freud’s son-in-law, Edward Bernays, it was the first to step into public relations.

Twenty-five years ago, no one could have imagined that the bulk of the treatment literature would be ghostwritten, that negative trials could be portrayed as glowingly positive studies of a drug, that controlled trials could have been transformed into a gold-standard method to hide adverse events, or that dead bodies could have been hidden from medical academics so easily.  Twenty-five years ago no one would have believed that a drug less effective for nerves or melancholia than heroin, alcohol or older and cheaper antidepressants could have been brought on the market and that almost as a matter of national policy people would be encouraged to take it for life.

3 COMMENTS

  1. My hat is off to you, David Healy.

    This is a very well written piece. Your choice of words, to lay out the facts, is precise and (as far as I can tell) accurate.

    I appreciate how you write, “There are probably something between 1000-1500 extra suicides in the US each year, triggered by an antidepressant – an extra 2000 -2500 in Europe,” and, “There are probably between 1000- 1500 extra episodes of violence in the US each year that would not have happened without antidepressant input and between 2000-2500 extra episodes in Europe. Some of these will include school or other mass shootings which were unheard of twenty-five years ago…” For, there, you say, “probably” – which is good (avoiding false certainty); furthermore, you refer to suicides being, probably, “triggered by an antidepressant,” and mention probable, “extra episodes of violence in the US each year that would not have happened without antidepressant input…”

    (“Triggered by” and “antidepressant input” are – to my way of thinking – quite reasonable phrases, to place together, *after* that “probably” word.)

    In my view, your word choice is very good – as you are avoiding false claims, of ‘certain’ *causation*.

    (Such is to say, you are – in my humble opinion – referring to *factor analysis,* in reasonable ways, herein; so, you are being positively ‘science-minded’ throughout.)

    But, most of all, I appreciate your explaining, that, “Prozac has also killed therapy – just like Prozac CBT has a hyper-focus on thoughts rather than the big picture. CBT has also become a conduit into antidepressant prescribing as therapists regularly suggest softening up a depression with pills.” (I deeply respect that statement.)

    Simply, I remain concerned, that the back of your book (Shock Therapy: A History of Electroconvulsive Treatment in Mental Illness) seems to strongly suggest, that *ECT* should be recommended to, “the nearly half of all clinically depressed patients who do not respond to drugs.”

    That advertisement, on your book (albeit, now six years old) would seem to contradict your lamenting the death of therapy, above, would it not?

    Respectfully,

    ~Jonah

    • P.S. – I erred in referring to the *back* of your book (Shock Therapy).

      Upon double-checking, I’m reminded: in fact, it’s your book’s *front flap* which concludes: “…for the nearly half of all clinically depressed patients who do not respond to drugs, this book brings much needed hope.”

      (And, of course, I should have mentioned: the book is not yours alone; it’s yours and Edward Shorter’s.)

  2. From The Aquarian Rosary, 1988

    Preface

    The planet entered a period of change on August 17, 1987, and will rapidly increase its struggle to adjust to a new frequency. We are being caught up in a heightened awareness by the cosmic influence whether we are ready or not.

    From August 17, 1987, until December 21, 2012, we shall pass through a period of transition, a cleansing. We, as a body of cellular life, have to be able to live together as interlocking cells at the human level. All life on the planet has to participate in the experience of preserving the planetary body. It is the role of humankind to act as the intelligence of the planet – the brain cells through which the Higher Mind can act.

    Humanity is being guided to seek and utilize invocations, rituals and a mental comprehension that will guide it in this adjustment. We are told repeatedly that the incoming energy will disrupt, incite lower or hidden, repressed emotions and contribute to mental illness, crime and disease. Rituals of great love and spiritual power which can be easily used with large numbers of people are not only needed to help them touch into the spiritual force of Will, Love-Wisdom and Active Intelligence, but will prove to be stabilizing tools of transformation during this critical quarter century.

    With these thoughts in mind, I offer the Aquarian Rosary as one tool to aid humanity in the Great Work that confronts it.

    *end of Preface*

    “Twenty-five years ago no one would have believed that a drug less effective for nerves or melancholia than heroin, alcohol or older and cheaper antidepressants could have been brought on the market and that almost as a matter of national policy people would be encouraged to take it for life.”

    I believe in what is written, in 1988 – “the incoming energy will disrupt, incite lower or hidden, repressed emotions and contribute to mental illness, crime and disease.”

    *shrug*

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