Depressives and docs look at life after Prozac

A recent study has found that Prozac is of little help in tackling depression

MUMBAI: For 20 years, men and women all over the world succumbed to the Prozac blitzkrieg: When the darkness of the mind threatens to overpower you, pop the green and white capsule which will shine brighter than JRR Tolkien's Star of Elendil and drive out the shadows. Eli Lilly's Prozac or fluoxetine hydrochloride spawned books like Elizabeth Wurtzel's Prozac Nation and along with the 'Smiley', it became a thriving symbol of 20th Century popular culture.

Now a new meta study, conducted by Irving Kirsch of Hull University, is threatening to topple Prozac from its happy perch. The researchers have concluded that Prozac and other similar antidepressants are essentially worthless, and that placebos are just as effective as drugs. The exception was in severe cases of depression where the placebos fared worse.

But Mumbai's psychiatrists are treating the study's findings — published in the Public Library of Science Journal — with the proverbial pinch of salt. Dr Kersi Chavda, a consultant psychiatrist with Hinduja Hospital says, “It is a known fact that for people suffering from moderate and major cases of clinical depression, therapy along with medication is more beneficial than either of them alone.”

Clinical depression is not about “feeling low” or sad, but can be linked to brain activity, in this instance, a drop in the level of neurotransmitters. What an antidepressant like Prozac does is increase the level of neurotransmitters or serotonin, which will result in a mood lift of sorts. However, contrary to popular belief, the result is not instantaneous — it takes about four to six weeks for the effect to kick in.

“And it's not about instant happiness,” says psychiatrist Dr Bharat Shah, Lilavati Hospital, who also emphasises the importance of therapy and counselling. “Yes, it's true that antidepressants may not cure some people, but it helps a large number of patients.”

The Hull University findings are no grand revelation. In a more comprehensive 2006 study, the US Food and Drug Administration (FDA) reported that while five out of 10 patients appeared to respond to the medication, four out of 10 also responded to the placebo. “Often, the people enlisted in such studies are not an accurate representation of real-life patients,” says Dr Shah. “What if those on the placebos are given extra care and therefore, respond to it?”

The problem arises when people opt for self-medication. Technically, antidepressants cannot be bought without prescription. But again, it's not Prozac that Mumbaikars turned to when the going got tough. “There was a time when people would turn to anti-anxiety drugs like Restyl indiscriminately,” says Dr Chavda.

Another reason why India has not yet become a Prozac Nation is because of its emphasis on social and family ties, which form an effective support base. According to Dr Chavda, even the crowd in the train play a positive role. “It's about physical contact,” he says.
 
So no, Prozac is not a mood enhancer; it will not offer instant happiness; and chances are it may not make you comfortably numb either. Perhaps the one good thing this study will achieve is make us look elsewhere in our quest for happiness.

t_anjali@dnaindia.net