Making Prozac Talk

A recent issue of Newsweek magazine carried a two-page advertisement for the anti-depressant Prozac. "Prozac isn't a 'happy pill,'" the ad defends. "It's not a tranquilizer. It can't take away your personality. Depression can do that, but Prozac can't."The little green and cream-colored pill that's been prescribed "for more than 17 million Americans" has been labeled both a miracle and a menace. Today, studies question the ethics and effectiveness of prescribing medication alone to treat depression. Parts of the research highlight the social causes of some depressive episodes as well as the therapeutic relationships that most effectively treat them.As critic Dr. Peter Breggin describes the mood-leveling drug in the July 1994 issue of Psychology Today, "Many people do not feel high or euphoric on Prozac, but react with a narrowing of their emotional spectrum. They lose touch with themselves and others, and may perceive this as a kind of relief."Still, some say the medication takes the edge off events and feelings that might normally drive them toward death or the depths of emotional darkness. Others point out how the drug's side-effects can become as debilitating and dangerous as depression itself. As far as its ability to cure or affect improvements in depression, studies disagree on its usefulness compared to exercise regimens, psychotherapy or even to the use of simple, placebo sugar pills.Prescribed for every malady and malaise from premenstrual syndrome to life-threatening clinical depression, eating disorders, obesity and temporary depression or motivation loss, the big P has become the most widely prescribed psychiatric medication in the most depressed nation in the world -- America. Almost half the American population has experienced depression. Studies show that as other nations modernize, industrialize and Americanize, the ranks of their depressed also grow.The origins of depression, researchers say, lie in every area of human experience -- in physical abnormalities, contagious and inherited diseases, life experiences, psychological patterns or harmful habits as well as in the impact of specific events and circumstances in our surroundings. In spite of its many different forms and causes, medical doctors and psychiatrists are prescribing the same, single medication over all other types of treatment to cure or improve the emotional and physical state we describe as depression.In America we use the term "depression" casually, as a label for a passing mood or temporary attitude. In clinical terms genuine depression shows up as a set of physical disturbances in the brain which affect or involve sleep, appetite, motivation, concentration, self-image and the ability to experience pleasure. Severe depression can bring sufferers to the point of considering suicide. In fact, according to an issue of the Harvard Mental Health Letter, half the 36,000 suicides each year can be attributed to depressive episodes.A Jan. 11 article in Science News magazine addresses a new analysis of the 1989 National Institute of Mental Health study comparing types of treatments for depression. The 16-week study is said to demonstrate little difference between using medications, placebos and psychotherapy. Most interesting is the analysts' conclusion that the relationship between the prescribing therapist or counselor and the patient "is more critical than the techniques a therapist employs or the drugs that may be prescribed."The article continues focusing on factors researchers found most effective for the 250 patients studied. "The therapists who facilitated the greatest improvements in depressed clients said that they focused on psychological factors, such as distorted thinking and feelings of helplessness, rather than biological disturbances. In addition, superior therapists generally used psychotherapy alone, rather than in combination with psychoactive drugs... (However,) clients who perceived their therapists as empathetic and caring responded best to anti-depressant drugs."Adding voices to the volume of critical debate leveled at a runaway trend in Prozac prescriptions, the eight-year-old study calls new attention to the importance of listening and genuine face-to-face communication. It may highlight the role of caring relationships in a heavily stressed, scheduled and specialized society bustling with competition, industry, technology and communication devices that may isolate Americans from close personal contact with their families, co-workers, friends and communities. As with the nationwide trend in prescribing Ritalin our insistence on seeking drug-based solutions may be keeping scientists and policy makers from asking deeper questions about the social causes of rising depression in industrial nations like our own.

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