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From the October 1st, 1995 issue of Smart Drug News [v4n5]. Copyright (c) 1995, 1998. All rights reserved.

Book Review:

Talking Back to Prozac

review by T. Michael Hardy

Talking Back to Prozac
by Peter R. Breggin, M.D., and Ginger Ross Breggin
St. Martin’s Press, ISBN: 0-312-95606-1, $5.95.

You know you’re in a pop-culture society when an antidepressant comes along and makes depression fashionable. Is it just me, or does this seem just a wee bit strange? Well, thankfully, I’m not the only one with such concerns, as evidenced by this remarkable book (or should I say investigative report) by Dr. Peter Breggin and Ginger Ross Breggin. Their book, Talking Back to Prozac, recently published in paperback, is an alarming wake-up call to the thousands who are being won over by a social word-of-mouth campaign that makes this drug seem like the best thing since sliced bread.

The book’s title is designed to be controversial — a pointed rebuttal to Listening to Prozac, the book that is credited with doing more to promote Prozac than all the public relation firms on Madison Avenue. Where Listening to Prozac was replete with nothing but praise for Eli Lilly’s star antidepressant, Talking Back to Prozac is a complete 180 degree opposite. The authors begin their book with the media circus that has made Prozac the subject of cocktail parties and full-cover Newsweek articles. Then they go on from there.

The Breggins contend with Prozac’s use for numerous conditions other than depression, the condition for which it was approved. There has arisen a Prozac “mythology” that has motivated people to ask their physicians for a Prozac prescription to treat everything from obesity to making them somehow “better.” While there was no shortage of praise and press concerning the wonders of Prozac, it was the publication of Listening to Prozac (and its many weeks on the bestseller list) that firmly established this antidepressant as a cultural icon. Some of the wonders of Prozac reported by Dr. Kramer, such as personality transformation and enhanced assertiveness, came from a very small group of patients who were clients in his private practice. The media response to Listening to Prozac was so far reaching that even Dr. Kramer found himself cautioning readers who had become enamored with the thought that a little pill would somehow improve their lives. The hoopla grew to such ridiculous proportions that Eli Lilly took out a full page ad to “decry the trivialization of the drug and the disease it was intended to treat: clinical depression.” It is also interesting to note that Dr. Kramer has been more cautious in his recommendations.

What is perhaps most amazing about the proliferation of Prozac use has been how readily it is prescribed by physicians. While it is indeed quite legal and common for physicians to prescribe medications for off-label usages, there is something very wrong with so many medical practitioners prescribing a medication for a patient who walks in and says, “I heard that Prozac will help me lose weight. I want some.”

Much of the information presented in Talking Back to Prozac is seen here for the first time. In several cases, the authors had to obtain documents from the FDA via the Freedom of Information Act. Their investigation into how the study protocols for the clinical studies of Prozac were designed and conducted are quite disturbing. What they discovered is that numerous clinical trials comparing Prozac against placebo showed the placebo to be more effective! Other studies where Prozac was compared to an older antidepressant, imipramine, showed the older drug to be more effective. What the authors discovered is that Eli Lilly essentially fiddled with the numbers of various trials, pooled those results that could be considered positive, then presented that to the FDA for approval. The shenanigans of Prozac’s approval may be the tip of an iceberg; how many other drugs studies are conducted in such a manner?

Personally, I found the most disturbing aspect of the book to be the accounts of Prozac survivors, people who took the drug and suffered horribly because of it. There are horror stories of violence and suicide that sent a chill down my spine. There are so many ex-Prozac users that they have banded together in Prozac survivor groups, small support groups which include family members as well. Some of the accounts presented by the authors were almost identical to some of the experiences I have heard from CERI subscribers.

Over the past few years, I have spoken to a number of physicians and psychiatrists who have privately expressed their professional concerns about Prozac. After reading Talking Back to Prozac, I think I now know why these concerns were expressed privately. It seems that Eli Lilly has implemented a policy of paying the legal fees of any physician who prescribes Prozac for an indicated use and is sued for malpractice. This gives the reader an indication of just how determined Eli Lilly is to keep their star drug on the market amidst the controversy.

Another interesting tactic employed by Lilly and others in the defense of Prozac is to allege that Prozac survivor groups and other critics are somehow agents of the Church of Scientology or dupes of their smear campaign against the drug. Although this may be a underhanded and dishonest tactic, it is understandable in the light of Eli Lilly’s billion-dollar annual Prozac sales.

I was disappointed that the authors failed to discuss the use of tryptophan as a Prozac alternative (to elevate levels of serotonin in the brain), and their failure to discuss the FDA’s ban of that amino acid. Perhaps Dr. Breggin is simply unfamiliar with the use of tryptophan and the strange circumstances in which it was banned from the U.S. market. I found myself wondering how successful Prozac would be if it were forced to compete with a safe and inexpensive nutritional supplement.

Each page of this little paperback is chock-full of pertinent and timely information for anyone who is using or knows someone who is using Prozac. There is an old saying: if something sounds too good to be true, then it probably is.