Drug info - Happy Birthday Prozac (Fluoxetine)

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Thursday, May 17th, 2007 Prozac is 20 Years Old - Time to Learn the Facts

It’s sold as happiness in a blister pack - a cure-all that has changed the way we think about wellbeing. As Prozac reaches its 20th birthday, Anna Moore presents 20 things you need to know about the most widely used antidepressant in the world.
The Observer
1: Depression has deepened
In 1971, when LY110141 - the compound that became Prozac - was developed, depression was rarely discussed and antidepressants largely restricted to the psychiatric unit. People went to their GPs with ‘anxiety’ and ‘nerves’. Tranquillisers such as Valium were a likely response.
Eli Lilly, the company behind Prozac, originally saw an entirely different future for its new drug. It was first tested as a treatment for high blood pressure, which worked in some animals but not in humans. Plan B was as an anti-obesity agent, but this didn’t hold up either. When tested on psychotic patients and those hospitalised with depression, LY110141 - by now named Fluoxetine - had no obvious benefit, with a number of patients getting worse. Finally, Eli Lilly tested it on mild depressives. Five recruits tried it; all five cheered up. By 1999, it was providing Eli Lilly with more than 25 per cent of its $10bn revenue.
Fluoxetine was handed to Interbrand, the world’s leading branding company (Sony, Microsoft, Nikon, Nintendo) for an identity. The name Prozac was picked for its zap: it sounded positive, professional, quick, proey, zaccy. It was marketed in an easy-to-prescribe ‘one pill, one dose for all’ formula and came when the medical profession and media were awash with horror stories about Valium addiction.
Prozac hit a society that was in the mood for it. National campaigns (supported by Eli Lilly) alerted GPs and the public to the dangers of depression. Eli Lilly funded 8m brochures (Depression: What you need to know) and 200,000 posters. Previous antidepressants were highly toxic, lethal if overdosed on and had other nasty side-effects. Prozac was pushed as entirely safe, to be doled out by anyone. It was the wonder drug, the easy answer, an instant up, neurological eldorado. When launch day dawned, patients were already asking for it by name.
Twenty years on, Prozac remains the most widely used antidepressant in history, prescribed to 54m people worldwide, and many feel they owe their lives to it. It is prescribed for depression, obsessive compulsive disorder, panic disorder, eating disorders and premenstrual dysphoric disorder (formerly known as PMT). In the UK, between 1991 and 2001, antidepressant prescriptions rose from 9m to 24m a year.
Strangely, depression has reached epidemic levels. Money and success is no defence: writers, royalty, rock stars, supermodels, actors, middle managers have all had it. Studies suggest that in America, depression more than doubled between 1991 and 2001. In the UK, an estimated one in six people will experience it - and it costs more than £9bn annually in treatment, benefits and lost revenue. Meanwhile, according to the World Health Organisation, depression is set to become second only to heart disease as the world’s leading disability by 2020.
2: Bio-babble has replaced psychobabble
Serotonin was not well known 20 years ago. Now, if you ask the person sitting beside you what it is, he or she may tell you it is linked to happiness, that levels get low in depressed people … that Prozac tops them up … so does chocolate … or aerobics … maybe yoga …
Except it isn’t strictly true. Or has been repeatedly challenged. And is yet to be proven. According to David Healy, professor of psychiatry at Cardiff University and author of Let Them Eat Prozac, it’s pure ‘bio-babble’ which has replaced the psychobabble of the Sixties and Seventies. Healy spent a decade studying the neurotransmitter serotonin in depressed people and found little evidence to support the theory of ‘chemical imbalance’.
‘The idea was forwarded in the Sixties - and the man behind it, Dr George Ashcroft, later took it back,’ says Healy. ‘Through the Seventies and Eighties, it was seen as a simplistic idea; now it’s seen as very convenient - it sounds so neat. There’s something in you that’s low that needs to be put right. It makes you happier to take a drug.’ (Witness Brooke Shields, who described it as ‘comforting’ to discover her depression was ‘directly tied to a biochemical shift’. Or the writer Lauren Slater in Prozac Diaries describing Prozac as ‘a drug with the precision of a scud missile, launched miles from its target only to land, with a proud flare, right on the enemy’s roof’.)
Prozac is a Selective Serotonin Reuptake Inhibitor (SSRI). Previous tricyclic antidepressants (TCAs) worked on three neurotransmitters associated with mood (serotonin, dopamine and noradrenaline) whereas Prozac just concentrates on one: serotonin.
‘The idea that it’s been a major step forward for Prozac to select serotonin only is just hypothesis,’ says Malcolm Lader, professor of clinical psychopharmacology at the Institute of Psychiatry. ‘There’s no science behind it.’
The theory that emotions are governed by serotonin levels is highly simplistic and works just as well the other way around (ie, our emotions, our stress levels alter our brain chemistry, so it’s at least a two-way street). Other important factors that contribute to depression include life experience, family history, hormones and diet. However, the oft-repeated ‘chemical imbalance’ theory (the fault is not in ourselves, but in our precious bodily fluids) is promoted on depression websites owned by drug companies and in advertising.
And just like scuds, Prozac turned out to be less precise than originally supposed. Experiences with it range from miraculous to mediocre. The writer Zoe Heller found that within weeks of taking it, she stopped crying and could get out of bed. Others describe it as a detached benevolence, or a comforting numbness. It makes some people feel anxious, agitated and unable to sleep. There are those who stop taking it, as they feel no effect at all.
Interestingly, reports gained through the Freedom of Information act revealed that in half the 47 trials used to approve the six leading antidepressants, the drugs failed to outperform the sugar pills. When they did, it was by only two points on a 52-point depression rating. Frosties, anyone?
3: You never too young
Enter liquid Prozac in peppermint flavour. In the US, a survey of drug companies found that between 1995 and 1999, use of Prozac-like drugs for children aged seven to 12 increased by 151 per cent, and in those aged under six by 580 per cent. In 2004, children aged five and under were America’s fastest-growing segment of the non-adult population using antidepressants. ‘Selective mutism’ (fear of speaking in social situations) is one affliction common in preschoolers and has been treated with Prozac.
In the UK, too, the trend has been upwards. Between 1992 and 2001, prescriptions of SSRIs for under-18s increased tenfold - despite the fact that none has a licence for use in children. In 2003, the NHS warned against all SSRIs in under-18s except Prozac, after studies showed they rarely performed better than a placebo, and came with disturbing side-effects.
In America, the SSRIs, including Prozac, now carry a ‘black box’ warning that the drugs could increase suicidal behaviour in children. It’s thought that prescriptions are falling in both countries as a result.

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Good find