Readers On Prozac

Readers' Take (on) Prozac

Hi Mark, I just wanted to let you know I have been depressed and taking 40mg of Prozac for three years (along with therapy weekly). The only side effects I had were appetite loss and vivid dreams. I am very fortunate to have found a medication that helps me. My depression has greatly decreased and I'm able to carry out a "normal" life.

There is a great book called Talking Back To Prozac (what doctor's aren't telling you). It is by Dr. Peter R. Breggin. You might find it interesting. I purchased it through Amazon.com books, it was only $5.00. Thanks for your interesting newsletters and stay well. Sincerely, (Debbie) [Ed Note: Will now also consider this salutation, "Surreally yours"]

Good newsletter Mark. Do you think that those who have "low blood sugar," generally speaking, are basically depressed? That is, does depression CAUSE low blood sugar? I have heard that it is vice-a-versa, but am wondering if depression itself can cause it? I have seen so many people with lots of problems and feeling over-whelmed by life, that then get hypoglycemia. I have had the problem myself, and have found that diet has helped, but am still anxious and have occasional depression. Thanks, and Happy New Year!! Marilyn

Hi Marilyn,

Thanks for the thoughtful note. My sense is that prolonged, if not chronic, stress lies behind both, in addition to any genetic predisposition. Clearly low blood sugar can create mind-body effects that seem like depressive symptoms and people may mistakenly think and label signs of depression as simply low blood sugar. Anyway, that's my take.

To an energetic New Year.

>From Lilly http://www.prozac.com/general.htm

Let me know if you get through to this link?

I just read the site again Lilly, says 6mos is recommended time for AD-s [antidepressants].

What do I know? If the stuff wasn"t so expensive I would give it to my dog first to see results but I can get info on the web sooner and less chance of getting bit. (forgive pun)

Anyway you seem to have a handle on it, I am the one mixed up about the whole deal. Sorry to trouble you. Am lookin foward to AOL chats if I can find them. Many thanks

AL S

Thanks for the link. Yes, I read where the recommended time for Prozac is 6-12 months. What I didn't read is that there's a contraindication for longer usage. I suspect they are including the 6-12 month range to educate people who think depression is quickly fixed with Prozac. And, I suspect (hope) that if there was research stating damaging side effects of long term use then that would be reported by the FDA (if not by Lilly). But as always, consumer beware!!

Noting with interest your information on use of Prozac, I thought I would let you know about a new book called The Second Brain, by Michael D. Gershon (Harper Collins, l998). The impact of seratonin on the guts is profound because, as a separate nervous system parallel to the brain and activated by exactly the same neurotransmitters at differing sites, it seems to be related to an increasing epidemic of bowel disorders. First it stimulates gut motility, then depending on does and length of use, burnout, leads to dismotility. The problem is that gut function is the last connection that doctors or patients make concerning psychotropic drugs.

The book is within a determined layman's grasp. It is, however, without an index or footnotes, with suggests to me some degree of haste. As confirmation of its thesis, the new drugs for Irritable Bowel Disorder, are anti-seratonins. I can't help wondering what it must feel like to make yourself have less seratonin. [Ed. Note: Living a life of high anxiety and panic, helplessness and depression should do it.]

Best Regards, Kirsten

hi stressdoc, happy new year and all that happy bloody stuff. thanks for all the efforts you put in for us mentally disfunctioning dudes and dudettes out here in cyberspace reading your work. i have dropped the the prozac meds trial after 6 weeks and have switched to remeron. i felt all that prozac was doing for me was making me less nervous about feeling so apathetic, although as you noted this was probably more impatience toward not reaching some sort of functional state quick enough. needless to say the remeron does not feel much better but i am going to stick with it and give it a chance. the last time you wrote to me personally you asked whether i was including group or interpersonal therapy and whether i had a support group or family to lean on with my meds trial, well i was going to write back but got into and have been in one of my lowest and most disinterested moods that i have been in for a very long time. i hear what you say about the human interaction and therapy but the problem for me is that i have been a loner for most of my cognitive life and generally do not get along with and dislike most humans, disowned my own family a long time ago and could probably say i have only had one relationship in my lifetime that did not end disastrously.

why am i telling you this when i know you've probably heard every depressive story there is to hear in this world? i suppose i just want you to tell me that it is possible to get back without human intervention and the meds will eventually make it all right again, okay, i know you are going to say "wrong," like most people do who are trying to help me but as we know we are creatures of habit and i have spent a lifetime building a wall around myself trying to isolate myself from society and as i sit writing to you trying to think of something to say that could spark the magic words from your great wisdom and insight that would change me back to having some zest for life, i have to wonder whether i would listen because it seems deep within myself through the trials and tribulations of life which to me for myself seem to have been unnecessarily hard and unhappy like a nail that has slowly been hammered into wood there's not much left sticking out to hit. my spirit feels very tired and mangled and i just want to give up, i do not feel suicidal but everyday i really just wished that i could go to sleep and not wake up. nothing interests me and even getting this far with this letter has surprised me, not to mention thoughts in my head of just how rude it is downloading this crap on you anyway, (sorry) anyway i'm going continue on the meds track and hope that one morning i'm going to awake a happy smiling person all interested in life. thanks for your ear if you got this far without hitting the trash button.

mark, congratulations on your site award, in my humble opinion you really deserve it. keep up the fantastic work and all the best. sean

Sean, First of all, thanks for the very poignant and well-written email/essay. You should be doing more writing if you aren't. Second, I'd like to reprint it anonymously in my next newsletter. How about taking a creative writing course at some point? But I get ahead of myself. I'll make a bargain with you: I won't suggest human interaction (for now) if you'll start a physical exercise program, even if it's just brisk walking, gradually building up to 30-45 minutes a day.

To hard work, some inner peace and some support. Mark

mark, thank you, your mail really made me feel good and you are welcome to use what i wrote, i take heed of your words and am trying to crank that old handle to get back up to speed. have a lovely weekend sean

Hm-m-m...interesting article on the "murderous" side effects of taking Prozac. I took Effexor for a good part of last year because of a diagnosis of Post Traumatic Stress . Went through the whole schtick...talked to my doctor about feeling depressed, and after a rather lengthy evaluation by my Psychiatrist I was told I was not clinically depressed, but PTS-ed. I tried Prozac and another med, but got rashy...hence the Effexor. BUT, in the process of reading everything I could get my hands on concerning the meds, a kind of universal aspect of these meds is that they take a while to "kick in", on the average, around three weeks minimum. How long were the people with criminal actions on the meds before they became violent? And I certainly was told of all the drug interactions possible between all my meds prior to initiating treatment...including the interactions with alcohol, etc. Guess my VA hospital is pretty on the ball here in Colorado. And hey, Mark...best to ya in 2000 and thanks once more for all your good work. By the way, I'm doing a really important paper...could you give me statistics on....ahahahahahahhahaha! (Ed note. For those who recall the last Q & A, you'll know this emailer is a real wise guy ;-)

REALLY good article! It clearly explains the myriad of feelings possible when depressed, and the accompanying throughts regarding initiation of a meds trial. Its satisfying to reconfirm that I made the correct decision for me to bring my feelings up to my doctor. I knew something wasn't right, and I also knew that even though I could intellectualize what was happening, I COULDN'T CONTROL IT TO ANY DEGREE WITHOUT SUFFERING EVEN MORE. I'm off the med now, because of reactions to the med I was using, but I wouldn't hesitate to begin a new trial if my therapist recommended that it was needed. How marvelous to look forward to 2000 as the year of joy. God bless you for the wonderful work you're doing. Syl

Mark, Thank you!! You so eloquently explain the unexplainable. I'm forwarding this newsletter to (my husband), my in laws and my parents. This contains the answers to questions I didn't even know to ask. I'm so thankful to have your help on this journey.

Be well, Nance

Thanks Nance,

Your heartfelt words also touch me and help validate my struggle to make sense of a once very confusing, at times overwhelming, extended period in my life. And also help reaffirm my identity as a writer with a message. We all need that occasional reaffirmation. To the good fight.

DEAR DOC, THIS IS MY THIRD LETTER TO YOU ABOUT VARIOUS SUBJECTS AND YOU HAVE HELPED ME SO MUCH. YOU ARE MY GROUP, MY ALANON MEETING AND MY OUTLET.

UNLESS I MISSED SOMETHING IN YOUR NEWSLETTER IT SEEMS TO ME IF PROZAC OR ZOLOFT[MINE] WERE AROUND YEARS AGO THERE WOULD BE FEWER ALCOHOLICS. THEN THERE WOULD NOT BE THIS MIXING. I FEEL MOST PEOPLE WHO STARTED TO DRINK, ESPECIALLY HEAVY ARE IN REALITY DEPRESSED. WHAT ARE YOUR THOUGHTS, IF YOU FIND THE TIME? SHEILA

Hi Sheila,

I definitely agree. Unfortunately, if someone is abusing alcohol and is addicted to some degree, first the individual needs to withdraw from the alcohol. They have habituated to a poison in the system. Once detoxed, and in alcohol treatment, then I would start the antidepressant meds trial.

If not addicted to alcohol, then hopefully the meds could treat the depression for which people are self-medicating through alcohol. But let's not think antidepressant meds will automatically or alone cure a well-established pattern of drinking. But I also agree, earlier appropriate treatment for depression will likely reduce later problem drinking.

But you raise an important point. Thanks much. And thanks for the kind words. ~~~~~~~~~~~~~~~~~~~~~~~~~~~

Mark, Beautifully done with lots of care. For those of us in 12 step programs, you might add:

"Rule 13 for drunks, addicts, etc. Talk over any strategy involving meds with your sponsor, and be sure your doctor knows about your alcoholism/addiction. Make sure the doctor or therapist has read at least chapter 2 of the big book of AA. "

We could argue about whether AA or the like is a "station on the journey of life," or a different way of living, but that would belie the intent of your suggestions.

Best regards, David G

Dear David, Thanks so much for your very thoughtful and touching note. And I especially appreciate the sensitive way you note a possible difference. I agree, it certainly can be

Very thought -provoking. ABC Nightly News ran a cogent story tonight (1/6) re: employers' rights to employees' personal computer time while on the job, and segued nicely into the ease with which employers can access the data-bases from their paid-for insurance companies w/ regard to (previously thought to be private medical info of their employees, including anything authorized by that company: any/all prescribed meds and reasons for them, psychiatric referrals + reasons, number of doctor/specialist visits, potentially chronic conditions, etc., which might be of use to the employer to determine Hire / Fire status or promotability of any employee. Is it any wonder that people hide from that Big-Brotherism to keep the wolf from the door? I know that I personally will abstain from seeking help from anyone who keeps records that might be used as an eventual weapon to destroy me /mine. It is rapidly becoming a marketplace where only those who can afford to pay cash upfront will be able to buy and keep their own records, and the older we get the thicker the dossier. Michelle

I thought these were superb articles. Having been in and out of recurrent major depression for the last five years, and having read very extensively on the subject, I thought your articles caught all of the salient issues. Your personal experience has obviously added to your total sensitivity to the many issues involved.

I'm currently on 3 antidepressants! Pamelor (the old tricyclic), Zoloft and Celexa, along with a small dose of Klonopin. The doc that told you Zoloft and Prozac are alike was INCORRECT. In my case, Prozac worked superbly on the depression - more effectively than anything else (and I've tried almost all of them). However, it gives me a very painful arthralgia of the joints! Wierd. Every time I would take a step, I would get horrible shooting pains in my ankles, knees, etc. Wish it wasn't so. It was so effective on the depression.

I ended up on this concoction after extensive trials, under supervision of a psychiatrist. It really is trial and error. And the meds were never a total solution for me. I've had too many situational factors playing a partial role.

As a former medical group business manager, I can tell you that managed care would like to eliminate psychiatry altogether. As you know, psychologists have been seeking prescription rights (which is WRONG). I think MC wants the family doctor to medicate and to use counselors as an adjunct and eliminate the psychs.

Also, you're right on about "come back in a month, or three months." My own physician is excellent and never did this, but I have seen severely depressed people be given medication and told to return at some distant date. In one case the patient lived alone. This invites a fatal outcome, if you ask me. The meds will not work for weeks, and it's just denying any care at all for the person in the meantime.

I'm glad you mentioned that depression can be a fatal illness. All doctors should know this. However, I have found a very real bias among general physicians against shrinks. To put it frankly, they largely consider them to be quacks. I have heard these discussions myself - I'm not just guessing here. What a sad situation. Medical professionals think that if you can't "prove" an illness by a definitive lab test result, or an mri, or some form of concrete evidence that it largely doesn't exist.

In many cases, general docs are as ignorant of mental disorders as the general public. When I became depressed, the docs I worked for had me audited and then fired me. I had worked for them for fifteen years. Nothing was found to be wrong in the audit - they just don't want you around with a psych diagnosis. As I believe I've told you in the past, a physician in the group and another manager also had to leave with major depression. They never considered that the workplace they had created had a part in all that mess.

You are also right on about the patient's feelings about the illness - I couldn't understand why I couldn't cope this time - after all, I had been able to adjust and cope all my life. What had changed? I suspect that you're right - the body compensates somehow for many years and then with age and wear/tear - the system breaks down somehow and decompensation occurs.

I am still somewhat troubled by taking medication. At one time I was taking twelve psych drug pills a day. I feel pretty decent most of the time - but I am not "Me" as I was before. I sense a blunting of emotion and a most striking loss of the sense of urgency. Kind of a "I don't really care attitude." Hard to tell if that's medication, or lingering depression. It's hard to define the changes on medication. They are very subtle.

When I try to go off, I end up sobbing all the time. That could be withdrawal from the drug, rather than depression. How complex and difficult to decipher.

Also, I work in great spurts of energy - don't sleep but every other day. Then I'm comatose for a day. Yet I don't want to regulate this. Somehow I like it. When I get into my work, I want to roll forever. It's a sense of, "I better take advantage of this feeling before it's gone." (Maybe I'm bipolar after all?)

Enough of this prattle. I wanted to commend you for the accuracy, depth and breadth of the issues you touched upon. Very sharp and very current and full recognition of current financial and social issues as well.

I've been expecting deaths from the indiscriminate pushing of drugs over the Internet, haven't you. It was a disaster waiting to happen - why was it not prohibited?! Reprehensible - make a buck and never mind if you kill someone.

Isn't there a level on which you like all your own quirks? Sure, they get in the way sometimes, but they make you who you are. I know I'm not fully willing to give up all of mine. They're familiar - and they're MINE/ME. On the other hand, I don't want to cry night and day either. Oh, boy! It's difficult.

Keep up the superb work! It will help many people!! T.

Re: Newsletter JAN 2000. No. 1, Sect. 2 I must be moderately depressed. (1) I get teed off and at age 79 strain to keep up no metter what. (2) I get EXHAUSTED trying constantly to understand this world with a mental IQ of zero. (3) I wildly enjoy my escapes to eating, tv watching, and playing computer games. (4) I told my doctor to take his anti depressants and stick them where the sun doesn't shine. (5) WOW!!!~ I KNOW that my edge is gone. (6) I "treat" myself since I have a minor in clinical psychology. Who wants a psychiatrist messing up your psche? (7) See item #6. (8) Slow sex drive. How about no sex drive? (9) I am not moved to tears but I am concerned about my love for the violence in WW II movies. (10) The miles have mounted. My back is gone. Every body joint is arthritic - arteries are hardening - and I need to trade my "car" in on a new one. (11) I am a real old dog. I simply fail to recognize the new tricks to learn. (12) Nuts - I have wasted our time. I forgot that you were trying to assist me with information related to Prozac, etc. - thus my memory is gone. MARK, you have written a fine newsletter. I am just letting you know that I have read and appreciate the content. Thanks for keeping me on your mailing list. Andy

Thanks Andy. Your feisty attitude and capacity for absurdity, self-effacing (and skewering) humor make you our poster boy to inspire us to....Practice Safe Stress!

Mark Gorkin, LICSW, known as "The Stress Doc," is the Internet's and America Online's "Online Psychohumorist"™. An experienced psychotherapist, The Doc is a nationally recognized speaker and training and OD consultant specializing in Stress, Anger Management, Reorganizational Change, Team Building and HUMOR! His writings are syndicated by iSyndicate.com and appear in a wide variety of online and offline forums and publications, including AOL's Online Psych and Business Know How, WorkforceOnline, Mental Health Net, Financial Services Journal Online, Paradigm Magazine and Counseling Today. Check out his USA Today Online "Hotsite" Website -- www.stressdoc.com . For info on his workshops or for his free newsletter, email stressdoc@aol.com or call 202-232-8662. Spring 2000, look for Practice Safe Stress with The Stress Doc™, published by AdviceZone.com.