Featured on the cover of Newseek and New York Magazine...debated on television and radio, written about in daily newspapers, Prozac has raised hopes and sparked controversies across the country. But how much do you really know about Prozac, the alleged "miracle drug" that doctors worldwide have employed to help alleviate crippling clinical depression in their patients?
The bestselling author of Moodswing, Dr. Ronald R. Fieve is one of the nation's foremost experts on Prozac and its uses. In a clear, concise and easy-to-use format, he provides detailed and authoritative answers to the most commonly asked questions about Prozac...giving essential information to help make informed decisions on this complex, often confusing, prescription, and offering interpretation of the effects of Prozac on personality as well as the dangers of prescribing Prozac to misdiagnosed patients.
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About the Author
Internationally renowned psychiatrist Ronald R. Fieve, M.D., is one of the foremost experts in the clinical use of Prozac as well as the pioneer in the use of lithium for manic depression in America. A gradutate of Harvard Medical School, extensively trained in psychopharmacology as well as psychoanalysis, he served his residencies in internal medicine at New York Hospital and in psychiatry at Columbia-Presbyterian Medical Center and the New York State Psychiatric Institute. Dr. Fieve is Professor of Clinical Psychiatry at Columbia University, a chief of psychiatric research at the New York State Psychiatric Institute, and the founder and president of the Foundation for Depression and Manic Depression in New York City. In addition to writing the bestselling Moodswing, he has also published Second Opinion on Lithium Therapy for Depression and Manic Depression and numerous articles in scientific journals. He maintains a private practice on the foundation premises at 7 East 67th Street, New York City.
Read an Excerpt
And The Psychopharmacological
Miracle Of Our Time
In my private practice, I have seen a few patients utterly changed by Prozac, lifted from the deepest despair into an even-tempered, confident optimism. Their lives improved so suddenly and dramatically that they seemed to have new personalities. More often, however, the changes are less spectacular. The patient returns from the paralysis of depression to a normal level of functioning. It is a shift back to wellness, a restoration of the self rather than a transformation.
One of my patients, K.S., is a 36-year-old former singer who had struggled for many years with "an undertow of depression." Born in the Midwest, she was sent to boarding school between the ages of 12 and 18, during which time her mother divorced, remarried, and moved to the East Coast with her new husband. After an Ivy League college education, K.S. sang in the chorus of a Broadway show, performed on television, and by age 26 went on a national tour. But ultimately, depression began to pull her down. "I was sent to see one doctor after another because I was supposed to be very nervous; finally one psychiatrist gave me mild tranquilizers, which didn't help, and then Thorazine," she recalled. "Later I found out that Thorazine is a drug that should be given only to psychotic patients and schizophrenics. Instead, I should have been given an antidepressant. With Thorazine I couldn't sing. I stopped taking it because it changed my facial expression, made my arms and legs stiff, and I even put on ten pounds. Needless to say, I also stopped seeingthe doctor."
For the next two years, K.S. remained down, functioning poorly. "Then I became increasingly disturbed, terribly unhappy, which must have been a deepening of the same old depression."
She underwent treatment with several psychiatrists who gave her antidepressant medications that did not work. In addition, she saw two different psychologists for psychotherapy. Throughout the medication and psychotherapy treatments, K.S. stated, "I was never happy, although after spending close to $10,000, I did gain a few insights. Whenever anything nice would happen to me, I would wonder why the depression did not go away. It was as if I had a dark cloud hanging over me and the treatment never touched it. I just couldn't function."
K.S.'s history revealed high energy as well as sustained periods of achievement during her teens and early twenties. Her family history included an uncle who had been treated for manic depression and a cousin who had committed suicide. With these two latter clues in mind, my experience allowed me to predict that K.S. would probably benefit from small doses of Prozac. This prediction was based on the fact that she had not only a diagnosis of chronic depression but also a past history of energetic, outgoing moods (hyperthymia) and a family history of manic depression.
The change came swiftly. "Within a week I started to feel much better," K.S. reported. "I decided I would try to swim. I decided that I really didn't want to die. I wanted to go on living. I decided to use the energy I had in the morning to start cooking again, since I had once been a gourmet cook. I got my old singing coach back. When friends came to the house for a cocktail party, they said it was like night and day because I had changed so much. They saw me as a completely different person more calm, confident, outgoing and energetic, and much more able to cope with everything. At times I wondered if I was getting too high, since this new personality, this new self, was foreign to me. In fact, it was the real me, which I had almost forgotten, because the depression had gone on for so many years. Although my friends thought that I had become transformed on Prozac, my husband who had known me since I was in college said that I had simply become the person I used to be."
For K.S., Prozac proved to be a miracle drug, but it has not enabled her to solve all her problems. Nonetheless, her spirits lifted dramatically. She is once again productive and creative, and her relationships with others have greatly improved. "My husband, strangely enough, does much more for me now than ever before," she noted. "Prozac has enabled me to shift away from depression, anxiety, and hopelessness and to move toward my previous more vivacious, energetic self. After ten years of depression, I'm delighted to be back."
In a sense, K.S. is an unusual case. Perhaps 90% of the patients who respond to Prozac will experience less dramatic results. They do not undergo anything even vaguely like a transformation. They simply come out of their depression. They get better.
Perhaps 10% of those who do respond to Prozac show an extraordinary reaction. Like K.S., these people are often misdiagnosed by physicians, therapists, and psychiatrists as suffering from anxiety neurosis, chronic depression, dysthymia or personality disorder. In fact, the patient has had a history of very mild to major manic depressive moodswings, ranging from those of the highly energetic, effective, slightly revved-up personalities to those with a family history of psychotic, hospitalized, suicidal, or manic depressive relatives. A physician who prescribes Prozac without recognizing the sometimes hidden elated or manic side of the patient's experience or heritage might expect only a gradual alleviation of symptoms not a sudden, sometimes dangerous, transformation. With this information, the physician should be able to predict the usual antidepressant response as well as the spectacular and immediate change that can occur. Without taking a detailed family history, which in K.S.'s situation showed manicdepressive illness in the family and an energetic, driving personality in her own past, the physician is unprepared for the dramatic turn-around experienced by someone like her. These transformations are not mysterious.Prozac. Copyright © by Ronald Fieve. Reprinted by permission of HarperCollins Publishers, Inc. All rights reserved. Available now wherever books are sold.