Prozac is whack?

“The Guardian", which is a newspaper publication from the UK, recently reported on the
results of a study indicating that Prozac and similar antidepressants do not work. The
authors of the study note that they obtained previously unreleased data that shows Prozac
and three other anti­depressants have no better impact on depression than does placebo.

Just to quickly review, Prozac is an antidepressant that is considered an SSRI (selective
serotonin reuptake inhibitor). It is thought to work through increasing serotonin levels in
the brain but the exact mechanism of why it helps people with depression is unknown.

In regards to the article from The Guardian, this “new” finding is something that we have
known about in the field of psychiatry for a long time. Some of the earliest studies of
Prozac and other antidepressants for depression showed that they did not work better than
placebo, especially in the patient population of 18 years­old and younger.

News releases like this, that end up all over the internet (this study had a link on the home
page of MSN) can be harmful. I worry that people will read this and decide that their
depression or other mental health problems can’t be helped by medications. Some may
seek other therapies that have even less data for working or no data. Some people may
not seek treatment at all; that could put people at risk for worsening depression, suicide,
problems in social life, and loss of production at work. Additionally, there are copious
amounts of data that antidepressants do work, especially in more severely depressed
patients.

I love the internet. I love the availability of limitless information and how fast I can look
things up. There is a big disadvantage to all of this, however; the fact that anyone can put
anything they want on the internet and there is minimal to no regulation of it.    Granted,
this particular article is peer reviewed, which means physicians have approved it, but it
still only looks at one side of an issue, and it was primarily written by people that do not
prescribe medications.

My point is that when you read anything on the internet, take it with a grain of salt and
question it. When it is a medical article like this one, there are a lot of reasons to do that.
Basically, most medical studies or articles have limitations and medical professionals are
taught to look for those and incorporate those into reading an article like the one in The
Guardian. Most lay­people do not have that kind of training, and, in this particular case,
it is a very important article that could affect tens of millions of people.

In deciding on medical treatments, your best bet is to get information from your
physician and not the internet. In 1995, in a review article on patient and physician
communication, Stewart showed that “Most of the studies reviewed demonstrated a
correlation between effective physician­patient communication and improved patient
health outcomes.”

Talk to your doctor, ask questions, write your questions down and bring them in.
Antidepressants aren’t the solution for all of those who are depressed.    I do think they
work best for those who are more severely depressed, but they also work better for those
patients who are educated on their illness and the treatment options, who are motivated to
improve, who have been open and honest with their physician, compliant with
medications, and adherent to healthy lifestyles. Maybe a lot of that is related to placebo
but then again, if that helps foster recovery and a patient tolerates the medication without
significant side effects, maybe it doesn’t matter. One thing we know for sure is that
untreated depression can lead to severe social, professional and health problems.

Is Prozac whack? I don’t have the exact answer, but, as a physician and psychiatrist, I
sure as heck could have a very good discussion about it with you.

Thanks to CMAJ 1995 Oct 15, 153(8).